TRYING TO GET PREGNANT: 14 FERTILITY MYTHS DEBUNKED

Posted in Health by woman2womenblog

We live in the era of informatics. Knowledge is easily accessible to us: we can learn virtually anything by just googling it. But paradoxically too much information many times leads to misinformation.

When it comes to fertility issues, there is a lot of disinformation going around. Therefore, it is no surprising what a recent survey showed: knowledge regarding ovulation, fertility, and conception issues is limited among women, and many tend to believe certain myths and misconceptions.

These are 14 fertility myths most people believe, but that science has debunked:

MYTH #1. Maternity wise, 40s is the new 30s

Our life expectancy is longer, and we tend to postpone maternity due to career or study purposes. From that aspect, the 40s can be easily regarded as the new 30s. Unfortunately, this is not true for our ovaries: by the age of 30, a healthy woman has about a 20% chance of conceiving each month, by the time she reaches 40 her odds drop to about 5%.

This is one of the most commonly believed misconceptions: unaware of the age-related fertility decline, many women start seeking help to conceive in their 40s, when they may have already missed the opportunity to become parents.

You should be aware that there is a biological clock, and it’s ticking! If for personal reasons you cannot have a child right now, you may freeze your eggs to use them in the future.

MYTH #2. Certain sex positions increase the chances of getting pregnant

You will find plenty of (mis)information on this topic! In general, it is said that the best positions for getting pregnant are the missionary position (the woman lying on her back, her partner on top) and the “doggy position” (rear vaginal penetration, with the woman on her hands and knees) because they provide the deepest penetration, allowing the man to ejaculate closer to the opening of the cervix.

In fact, there’s no scientific evidence to prove that. This belief is largely based on a single study that looked at the position of the penis in relation to these two sex positions, but it didn’t address pregnancy chances at all.

Therefore, no position seems to be better when it comes to maximizing your chances of making a baby. Sperm can be found in the cervical canal just a few seconds after ejaculation, and within 5 minutes in the tube, regardless of the coital position.

MYTH #3. Lifting your legs in the air for 20 minutes after having sex will help you get pregnant

You have probably heard this one: “lie in bed with your feet in the air after having sex to increase your chances of getting pregnant”. In fact, this is not (totally) true. You may lay in bed for 10-15 minutes after intercourse, as by this time the sperm have largely reached the cervix, and many may even be inside the tube.

In fact, a new study challenged both beliefs: women having artificial insemination were split into two groups – one that rested on their back with their knees raised for 15 minutes after the procedure and one that got up immediately. It turned out that, after several courses of treatment, 32% of the immobile group fell pregnant, compared with 40% per cent in the active group.

Therefore, there is no need to put pillows under your bottom during intercourse to get an advantageous tilt, or to perform cycling motions with your feet in the air.

MYTH #4. If we have sex every day the sperm becomes too weak, reducing our chances of getting pregnant

How often should we make love to boost our chances of pregnancy? You will find all sorts of advice on the web: every other day, 3 times a week, every single day! Which one is correct?

One thing is clear: abstinence intervals greater than 5 days impair the sperm number and quality. Nevertheless, there is not much difference whether men ejaculate every day or every other day. Most fertility specialists used to recommend intercourse every other day, as this would increase sperm quality, particularly in men with lower sperm counts (oligozoospermia). However, recent studies show exactly the opposite: oligozoospermic men had better semen quality with daily ejaculation!

Recent scientific evidence suggests that making love every day confers a slight advantage: the highest chances of pregnancy (37% per cycle) were associated with daily intercourse, although sex on alternate days had comparable pregnancy rates (33%). On the other hand, we should keep in mind that the “obligation” to have sex every day may induce unnecessary stress to the couple, resulting in lack of sexual desire, low self esteem, and ultimately reduced frequency of intercourse.

Therefore, reproductive efficiency is highest when you have sex every day or every other day. The optimal frequency, though, is best defined by each couple’s own preference.

MYTH # 5. We only have sex when I ovulate, on day 14 of my cycle

Ovulation (when the egg drops from the ovary into the tubes) occurs once a month, usually between day 11 and day 21 of the cycle (measured from the first day of your period).

Each woman ovulates on her own schedule. While it is usually said that a woman with a 28-day cycle ovulates on cycle day 14, that’s not necessarily true: a study found that fewer than 10 percent of women with regular, 28-day cycles were ovulating on day 14.

We know that sperm cells are able to survive in the reproductive tract of a woman for about 5 days, and that once the egg is released, it will die in about 12-24 hours. Therefore, the fertile period -or “fertile window”- is a 6-day interval ending on the day of ovulation.

To boost your odds to become pregnant, have sex before and during ovulation, every day or every other day. If your cycles are irregular and you cannot figure out your fertile days, you may use an ovulation predictor kit, or otherwise visit a specialist, who can help you find your fertile window.

MYTH # 6. Smoking doesn’t affect our chances of getting pregnant. I will quit smoking as soon as I get pregnant

You are most likely aware that smoking during pregnancy is dangerous, as it can lead to miscarriage, premature birth, low-birthweight babies and -according to recent studies– congenital malformations.

But you should also know that smoking is harmful for your fertility: smoking as few as five cigarettes per day is associated with reduced fertility, both in women and men, and this seems to be true even for secondhand smoking. It has been estimated that smokers may have a 10-40% lower monthly fecundity (fertility) rate, and that up to 13% of infertility is due to smoking.

Smoking can affect ovulation, as well as the ability of the fertilized egg to implant in the uterus. The effect of tobacco is so harmful for the ovaries that menopause occurs, on average, one to four years earlier in smoking women than in nonsmoking ones.

Men are also affected by tobacco: decreases in sperm density, motility, and abnormalities in sperm morphology have been observed in men who smoke, which impact a man’s ability to fertilize an egg.

Therefore, before trying for a baby, do yourself a favor … and put out the cigarette for good!

MYTH # 7. You don’t need to worry about your age. There’s always IVF

Another common misconception! Many women believe that, if age-related infertility strikes, they can overcome their problem by getting treated with in vitro fertilization (IVF). In fact, just as natural fertility declines with age, success rates with IVF also decline as a woman gets older.

According to the USA Center for Disease Control and Prevention (CDC), women younger than 35 years old have 33% chances of having a baby after IVF; for women ages 38 to 40 the success rate drops to 17%, while those 43 to 44 years old have only 3% chances of giving birth after IVF (using their own eggs).

IVF is not a guarantee to have a baby, and does not extend a woman’s reproductive life. Despite the number of celebrities having babies in their mid-40s and beyond, they may have not necessarily used their own eggs. While every woman has the right to keep her privacy, there is a wrong perception left that fertility treatments can extend a woman’s fertility span. There is a very low probability of improving success of conceiving after age 43 by using assisted reproduction using your own eggs. Nevertheless, you may opt to use oocyte donation (eggs of a younger woman) if age-related infertility stands in the way of parenthood.

MYTH # 8. A woman can’t get pregnant if she doesn’t have an orgasm

For men, things are clear: no orgasm, no pregnancy, as ejaculation occurs during orgasm. Well, that’s not entirely true: semen can be released during intercourse prior to orgasm in the so-called pre-ejaculation fluid, or pre-come (read more here).

For women though, getting pregnant has nothing to do with an orgasm. But could female orgasm improve the chances for conception? The answer is not clear.

Researchers have wondered for years about the purpose of female orgasm, and many theories have been proposed:

Just the pleasure it provokes, so that women want to reproduce and preserve the species!
The “poleaxe” hypothesis: orgasms make women feel relaxed and sleepy so that they will lie down after sex and the sperm reach their destination more easily.
The “upsuck” theory: the contractions of the uterus “suck up” the sperm released in the vagina and help them travel through the uterus to the tubes.
Pair bonding: the hormones produced during orgasm (such as oxytocin and prolactin) contribute to warm feelings towards her partner.

Orgasms are not necessary to get pregnant, but there are plenty of good reasons to have one! Nevertheless, it is not uncommon that women trying to conceive link the desire for an orgasm with their desire to have a baby; this leads to psychological pressure and difficulty achieving orgasm, adding frustration to a process that is supposed to be pleasurable…

Try not to consider the orgasm just as goal to get pregnant. Enjoy the intimate time with your partner, without any pressure. If you have an orgasm, great. If not, that’s fine, too!

MYTH #9. We’ve already had one child, so conceiving again will be easy

Perhaps, but it’s no guarantee. Many individuals experience secondary infertility, or difficulty conceiving a second or subsequent child.

Secondary infertility may be caused by age-related factors, both for you and your partner. Sometimes, a new underlying medical condition develops. Eventually, a fertility issue that always existed gets worse; while it didn’t prevent pregnancy before, now it has become a problem. A previous pregnancy may actually be the reason you don’t get pregnant again: surgical complications or infection after childbirth may have provoked scarring, which may in turn led to infertility.

Things change with time. Even if you got easily pregnant on your own before, if you’re struggling to have another child talk to your doctor, who can advice you on the next steps to follow.

MYTH #10. Infertility is a woman’s issue

Typically, the causes of infertility break down like this:

Approximately one third of the couples struggle with male infertility;
In another third, the problem is female infertility;
The remaining third will either face both male and female fertility issues, or a cause will never be found (unexplained infertility).

Common causes of female infertily are: age, PCOS (polycystic ovary syndrome), tubal or pelvic issues, endometriosis, and family history.

Common causes of male infertility tend to be from prior surgery, infection, or a problem present at birth.

As part of the preliminary work-up to determine the cause and treatment of infertility, both women and men will need to undergo clinical and specialized complementary exams.

MYTH #11. Men’s age doesn’t matter

While some men can father children into their 50’s or 60’s, men’s fertility isn’t age-proof: it starts declining in their 40s, although less drastically as compared to women’s fertility.

As a man ages, the concentration of mobile, healthy sperm and semen volume overall will decrease. It is clear now that men over the age of 40 have higher chances of having children with chromosomal abnormalities, causing miscarriages in their female partners. Moreover, researchers have found a direct link between paternal age and an increased risk of autism and schizophrenia.

A man’s age does matter. While men may not have a complete drop off in fertility like women do, “advanced paternal age” is something couples should be aware of. Men’s biological clock is also ticking!

MYTH #12. If I take good care of my general health, my fertility will be in check too

Whereas a healthy body and mind may boost fertility in certain cases, most infertility situations cannot be resolved by a lifestyle or diet change, particularly those related to age.

It is a common belief that certain diet types can help you get pregnant. There is no evidence that vegetarian diets, low-fat diets, antioxidant- or vitamin-enriched diets will increase your chances of having a child.

A woman’s weight plays a role in fertility: those who are either very thin or obese may find it hard to conceive. If you are trying to get pregnant, learn more about some lifestyle tips to boost your chances of getting pregnant here.

MYTH #13. If a man can ejaculate, his fertility is fine

Many myths surround male fertility and their sexual performance. It is a common (and unfortunate) myth that if a man’s fertility is compromised, this means his sexual performance is the problem. This is not true. Problems with sperm count, shape, and movement are the primary causes of male infertility.

Another common myth is that you can tell there is a problem with the sperm just by looking at the semen. In fact, even men that have no sperm cells at all (azoospermia) usually have normal-looking semen.

For the vast majority of men with infertility, there are no visible or obvious signs that anything is wrong. Healthy erectile function and normal ejaculation are not guarantee that the sperm is in good shape.

That said, erectile dysfunction can be a possible symptom of infertility; it may due to low testosterone levels or a physical injury. Difficulty with ejaculation can also be a signal certain medical problems. But these are uncommon signs of male infertility.

If you are struggling to get pregnant, have your partner check in with his doctor. A semen analysis will help clarify whether his sperm are fit for conception.

MYTH #14. The birth control pill will affect your future fertility

All scientific evidence agrees that hormonal contraceptives do not make women sterile. Moreover, they may confer increased likelihood of pregnancy with long-term use, and in certain cases they can also preserve fertility. Read more on the contraceptive pill here.

To summarize:

Myths and misconceptions regarding fertility and conception are, unfortunately, widely disseminated. This is a serious problem, as misinformation may lead not only to unnecessary stress, but also to take wrong decisions…

Get yourself well informed! Consult your gynecologist, who can help you with any concerns you have. Your doctor can also give you some tips on lifestyle changes to optimize your fertility, prescribe some exams, and tell you when to come back if you don’t achieve pregnancy on your own.

Last, a good piece of advice: if you want to get pregnant, have lots of sex – as much as you want, whenever you want – and enjoy it! After you have had sex, do whatever you want – just don’t smoke 😉

Photo credits

Intro: pixabay.com; 1: rma-fl.com; 2: motherandbaby.co.uk; 3: romper.com; 4: pixabay.com; 5: wsaw.com; 6: babycenter.com; 7: nexter.org; 8: irishtimes.com; 9: health.clevelandclinic.org; 10: thefertilechickonline.com; 11: businessinsider.com; 12: hayatouki.com; 13: livescience.com; 14: pinterest.com

12Jun2018

EGG DONATION IN GREECE: ALL YOU NEED TO KNOW

Posted in Health by woman2womenblog

Assisted reproduction techniques help thousands of couples with infertility to circumvent their problem and become parents. Nevertheless, when it is not possible for a woman to conceive due to poor egg quality or from having no eggs at all, she may still become pregnant by using eggs from a donor.

The first pregnancy with egg donation was reported in 1983, and ever since, more and more women are choosing this procedure to achieve their dream of having children. The main reason for this trend is that women are increasingly postponing childbearing until later on in life, when their fertility is often reduced; another reason is that over the years, the process has become highly successful due to recent technologies advances and improved freezing techniques.

What is egg donation?

Egg donation is a form of assisted reproduction by which a woman donates her ova to enable another woman to conceive. These oocytes are fertilized by the recipient’s husband sperm, or alternatively by a donor sperm.

The resulting embryos are transferred into the recipient uterus, which has been adequately prepared to receive them. The difference with routine in vitro fertilization (IVF) is that the egg donor is not the recipient; that is, they are two different women.

If pregnancy occurs, the recipient will have a biological but not a genetic relationship to the child, and her partner (if he provided the sperm) will be both biologically and genetically related.

What are the indications for egg donation?

Egg donation may be considered in the following situations:

Premature ovarian insufficiency: a condition in which menopause begins earlier than usual, usually before the age of 40 years old. In most cases the cause is unknown, but it may be the result of certain diseases, chemotherapy, radiotherapy or surgical removal of the ovaries. Egg donation is also suitable for women who were born without ovaries.
Low ovarian reserve: when there is a decrease in the number of eggs, resulting in reduced chances of pregnancy. Generally, this is due to advanced reproductive age, as the number of oocytes -and therefore fertility- decreases rapidly after the age of 35-40 years old.
Genetically transmitted diseases: women affected by, or carriers of a significant genetic disease who would prefer not to pass this disease on to their child.
Previous history of failure with IVF: especially when egg quality seems to be the problem.

Who are the egg donors?

1) Anonymous, voluntary donors: According to the Greek law, candidate egg donors are covered by anonymity and are required to sign a specific consent for the donation of their genetic material. In order to accept a woman into an egg donation program she should meet the following requirements:

Age between 18 and 35 years old.
She should be healthy, non-smoker, with no personal or family history of genetic diseases.

By law, the donor receives financial compensation only for the loss of working days, travel and other expenses incurred during the treatment cycle in which she participates. In any case, egg donation is an altruistic, anonymous and voluntary act.

2) Egg sharing: Women undergoing IVF may agree to donate their surplus oocytes to other women with infertility.

3) Known donor: a person who is known to the recipient, usually a close relative of friend. According to the Greek law, oocyte donation is an anonymous procedure, that is, the donor has no access to the child born, nor the recipient to the donor. Therefore, in Greece the donation of ova to known persons is forbidden by law.

Evaluation of the egg donor

Each candidate donor, after being fully informed about the egg donation program, completes a thorough questionnaire on her family, medical and psychological history. In addition, she is the subject of a series of exams to determine whether her health is in good condition and she can respond properly to the hormonal therapy.

The evaluation involves a comprehensive physical and gynecological examination, as well as the assessment of her psychological and mental status, her genetic material and reproductive system.

In addition, donors undergo the following laboratory testing:

Blood type and Rhesus
Hepatitis B & C
HIV 1 & 2
Syphilis
Hemoglobin electrophoresis
Sickle cell trait testing
Cystic fibrosis (CF) mutation
Fragile X testing
Conventional karyotype. It is also possible to a perform a molecular karyotype, upon request of the recipient couple.

A donor is ineligible if either the questionnaire or the screening tests indicate the presence of risk factors, or clinical evidence of an infectious or genetic disease.

Evaluation of the recipient couple

Adequate screening and preparation of the recipient couple are essential for the success of an egg donation program.

According to the Greek law, a woman is considered suitable to receive oocytes when her uterus has normal morphology and functionality and has not exceeded the age of 50 years.

The evaluation of the recipient couple is similar to that of couples undergoing routine IVF. First, the physician obtains a thorough medical history from both partners.

The assessment of the woman includes an in-depth physical and gynecological examination, a detailed pelvic ultrasound and laboratory testing. Briefly, the ovarian function, her blood group, and exposure to certain infections are examined. In addition, a Pap smear test and cultures for certain microbes (Neisseria gonorrhoeae, Chlamydia trachomatis, etc) are obtained.

In some cases, the uterine cavity is evaluated with hysterosalpingography (HSG), sonohysterography or hysteroscopy. If the woman is over 45 years old, a more thorough assessment of her cardiac function, pregnancy-induced hypertension and gestational diabetes risk are recommended. The effect of advanced maternal age on pregnancy will be discussed extensively, as well as any medical conditions that may affect pregnancy.

An embryo transfer trial before the actual procedure (“mock” embryo transfer) is strongly recommended. It allows to determine the best way to place the embryos into the uterus, and ensures that there are no unexpected obstacles along the way. Sometimes the cervix is very narrow and hinders the transfer of the embryos into the uterus; this may result in significantly reduced chances of pregnancy. In case of a narrow or distorted cervical canal, a cervical dilation may be recommended.

A treatment trial in a previous cycle with the same medications used for the endometrial preparations is proposed when possible, in order to assess the uterine response to hormone therapy.

The male assessment includes a semen analysis, blood group and genetic testing, among other exams.

According to the Greek law, the recipient couple should be tested for syphilis, hepatitis B and C, HIV-1 and HIV-2 within the six months preceding the treatment cycle.

The procedure

Preparation of the donor for egg retrieval

The donor follows the procedure of a standard IVF. Initially, she undergoes ovarian stimulation, that is, she receives a combination of hormonal medications in order to achieve the development of a sufficient number of oocytes within the ovaries; egg development is monitored by ultrasound and blood exams at regular intervals. When the oocytes are at the appropriate size, ovulation is triggered by an injection of human chorionic gonadotropin (hCG). Oocyte retrieval, scheduled approximately 34-36 hours after hCG administration, entails the use of a needle which is inserted through the vagina into the ovaries, whereby the eggs are aspirated under ultrasound guidance. The procedure is carried out under a mild sedation.

The ova obtained are evaluated for their maturity and then fertilized with the partner’s sperm, which has been processed in the laboratory. Donor sperm may be also utilized when indicated.

The male partner should provide the semen sample the day of the donor’s egg retrieval. Alternatively, if the presence of the partner is not possible on that day, the semen can be cryopreserved (frozen) at an earlier time.

Preparation of the recipient for embryo transfer

In order for the embryos to implant into the recipient’s uterus, the endometrium (uterine lining) must be prepared and synchronized with the donor cycle.

There are numerous protocols for endometrial preparation. Briefly, women who still have menstrual period may receive an injectable medication for temporary suppression of the ovarian function. When the donor starts ovarian stimulation, the recipient receives a hormone called estradiol to achieve endometrial growth. Estradiol can be administered orally or through a transdermal patch. Ultrasound assessment of endometrial thickness -and occasionally blood tests- are performed during this period. On the day after the donor receives hCG, the recipient begins treatment with progesterone. Progesterone causes endometrial maturational changes that allow the embryo to implant. Progesterone can be administered by intramuscular injection, vaginally or orally. Besides estradiol and progesterone, other medications may be prescribed if required.

The embryos are transferred into the recipient’s uterus, usually within three to five days after fertilization of the eggs in the laboratory. Embryo transfer is done using a thin catheter inserted through the cervix into the uterus. If the recipient couple has extra embryos, they will be cryopreserved (frozen). Thus, it is possible to transfer these embryos at a later time without the need for another egg donation.

Hormonal therapy with estradiol and progesterone continues until the recipient takes a blood pregnancy test (β hCG). If the test is positive, the hormones are continued during the first trimester of pregnancy.

Success rates with egg donation

Since egg donors are young and healthy women, success rates are higher than those obtained with conventional IVF. The age of the recipient does not seem to affect the success of the procedure. According to data from the National Agency of Medically Assisted Reproduction, the pregnancy rate with egg donation in Greece is 54%.

Nevertheless, the greater the number of attempts with donor-egg IVF, the higher the odds of success. Thus, it is estimated that the success rates after the third attempt reach almost 90% in most cases.

Many factors play an important role in the success of the procedure: adequate evaluation and preparation of both donors and recipients, optimal synchronization between them, high laboratory standards and well-trained scientific staff, will all have a positive impact on pregnancy rates in an egg donation program.

Risks of egg donation

1) For the donor:

Egg donation is a very safe procedure. Nevertheless, it is not entirely risk-free. Medicines taken to stimulate the ovaries, oocyte retrieval and the anesthesia required are all possible sources of complications. Briefly, the side effects of medications are usually mild, as one of the most feared complications in assisted reproduction, ovarian hyperstimulation syndrome is very rare in these cases. The remaining risks are estimated as follows: anesthesia risks: 1 / 10,000; risk of severe bleeding from oocyte retrieval: 1 / 2,500; risk of infection: less than 1/500.

It should be noted that the fertility of women who become egg donors is in no way affected. In fact, the eggs donated would have been otherwise discarded by their bodies.

2) For the recipient:

The possibility a donor transmits an infectious disease to the recipient is virtually non-existent, provided that proper evaluation of the egg donor has been performed, as dictated by the Greek law.

The most common risk for the recipient is the occurrence of a multiple pregnancy (twins) if more than one embryo is transferred. In any case, in egg donation cycles, the transfer of more than two embryos is strictly forbidden by the Greek law. If the couple is opposed to the possibility of a twin pregnancy, then only one embryo may be transferred (single embryo transfer, SET).

Pregnancy complication risk in recipiens with advanced age should be assessed individually for each case.

3) For the child:

To date, thousands of children have been born with this procedure, and the available data is reassuring, and equivalent to that of conventional IVF: the rate of birth defects is the same as the general population.

THE LEGISLATION IN GREECE

On Egg Donation

Egg donation is an altruistic act, voluntary and with no financial benefit. Donors are compensated only for the working days they lose as part of the donation process and their travel expenses.
Donation of ova and sperm is allowed in Greece provided donor anonymity is ensured.
Egg donation is not allowed to women over 50 years old.
Donors must sign an oocyte concession consent.
Recipients sign a document stating that they are married and accept to undergo in vitro fertilization with egg donation. If they are not married, they should sign a notary act stating that they wish to undego IVF using the egg donation method.

On Assisted Reproduction

On January 27 2005, the law 3305/2005 on the application of assisted reproduction techniques was reported.

The Greek law on medically assisted reproduction is one of Europe’s most flexible. It safeguards the couple who wants to have a child based on medical, biological and bioethical principles. Its main purpose is, ultimately, the protection of the child to be born.

Basic principles of the current legislation

Some of the key points of the in-force law are the following:

1) Assisted reproduction methods are legal and allowed for women up to the age of 50 years, as this is considered the limit for natural conception.

2) The donation of ova and sperm is permitted, but the consent of the spouse or partner is also required.

3) Pre-implantation genetic diagnosis is allowed with the purpose of diagnosing whether the resulting embryos are carriers of genetic diseases. Consent of the concerned individuals is required.

4) Sex selection is prohibited unless a serious sex-related hereditary disease is avoided.

5) Cloning for reproductive purposes is prohibited.

6) Cryopreservation of genetic material or fertilized eggs is permitted.

7) The use of a gestational carrier (surrogacy) is allowed. A surrogate is a woman who carries a pregnancy for another couple or woman, who wishes to have a child but is unable to get pregnant for medical reasons. The surrogate woman must undergo medical and psychological examination. There should be no financial transaction other than the costs resulting from pregnancy exams, loss of work, etc. The procedure requires a special permit from a judge.

8) Assisted Reproduction Units are established and operate with the permission of the competent Authority, which shall give its agreement and verify that the legal requirements are met. For any violation, it sets administrative and criminal penalties.

9) The law sets age limits for sperm donors (younger than 40 years old) and egg donors (younger than 35 years).

10) Single women are allowed to conceive with assisted reproduction.

11) Donors must undergo clinical and laboratory testing and are not admitted to donation programs if they suffer from hereditary, genetic or infectious diseases. The use of fresh semen from donor is not permitted; only frozen semen may be used.

More info at gofertile.eu

23Jan2018

FACT OR MYTH? TRUTHS, HALF-TRUTHS AND MISCONCEPTIONS ABOUT THE BIRTH CONTROL PILL

Posted in Health by woman2womenblog

When introduced in the 1960s, the birth control pill became a symbol of female liberation

The contraceptive pill made its appearance more than 50 years ago. Emerging during a period of social and political upheaval, it gave women the possibility to choose how and when to have a family, and to enjoy their sexual life. Thus, it is regarded as one of the greatest scientific inventions of the 20th century and one of the utmost symbols of female liberation.

From the very beginning though, this revolutionary method of contraception has been a source of controversy: some people thought it would create “a society with unbridled sexuality likely to undermine the foundations of the family”; others feared harmful effects and the birth abnormal children.

Fifty years later, the pill remains even more controversial than before and -paradoxically enough- more and more women are “liberating” from their “liberator”: the pill’s popularity is on the decline, a trend observed in many countries. The reasons behind this shift are many, but fear of side effects seems to the most recurrent. Arguably the web and social media, with the spread of countless personal stories with dramatic headlines and numerous pill scares have influenced women’s perception on the pill’s risks. But are these fears legitimate? How dangerous is the contraceptive pill? What is true and what is false?

Let’s see what science answers to the pill’s most common assumptions…

1) The pill harms your future fertility

FALSE. All scientific evidence agrees that hormonal contraceptives do not make women sterile in the long run. Sometimes it may take three to six cycles for fertility to fully return, but within a year after going off the pill, women trying to conceive are as likely to get pregnant (80%) as those who were never on the pill. In certain cases of long-term use, there may be even increased likelihood of pregnancy within 6-12 months after discontinuing it.

Moreover, hormonal birth control may preserve fertility by offering protection against pelvic inflammatory disease, endometriosis, ectopic pregnancy, ovarian cysts, ovarian and uterine cancer (see below).

2) The pill reduces sexual desire

MOSTLY FALSE. In most cases, birth control pills don’t affect libido (sexual desire): out of 10 women taking the pill, 7 experience no change in their sex drive, 2 observe increased libido, and 1 will feel less desire.

Recently, a study provided evidence that the pill does not kill desire: contextual factors, such as the relationship with the partner, stress, fatigue, family problems, recent childbirth, have a more considerable impact on sexual drive than the type of contraception used.

3) The pill makes you fat

MOSTLY FALSE. A recent extensive review study showed no evidence that birth control pills cause weight gain in most women. Although some persons may gain some weight when they start taking it, it’s often a temporary side effect due to fluid retention, not extra fat. And, like most side effects, it usually goes away within 2 to 3 months.

A woman’s weight may fluctuate naturally due to changes in age or life circumstances. Because changes in weight are common, many times they will wrongly attribute their weight gain or loss to the use of the pill.

4) The pill increases the risk of blood clots

TRUE. From the 1960s it is known that combined contraceptives pills may increase the risk of venous thrombosis, that is, a blood clot obstructing a vein, a serious and potentially life-threatening complication. Combined contraceptives contain synthetic versions of the hormones estrogen and progesterone. It is the estrogen that is mostly associated with the formation of blood clots, but the latest years it became evident that the type of progesterone also influences the risk. Indeed, the most “modern” formulations of the combined pill – the so-called third and fourth generation – containing the synthetic progesterones gestodene, desogestrel and drospirenone are associated with higher risk of thrombosis.

The European Medicines Agency (EMA) provides the following values for the incidence (frequency) of deep vein thrombosis in 100,000 women of childbearing age:

5 to 10 in non-pregnant women who do not use oral contraceptives,
20 for women using a second generation combination pill (containing levonorgestrel),
40 among women taking third and fourth generation pill.

Factors that may increase the risk of thrombosis are smoking, high blood pressure, obesity, age over 35 years, and a family or personal history of vascular accidents.

Although these figures may look scary, they should be analyzed in perspective:

In absence of risk factors, the absolute risk of thrombosis is very low.
The mortality rate of clotting events is about 1%. Thus, the odds of dying as a result of having a clot attributable to the use of the pill would be about 2 to 4 per million women.
The risk remains considerably lower than that related to pregnancy and birth (estimated 1 in 1000- 2000 deliveries).
Indicative of this is the 1995 pill scare in the UK, when a warning was issued on the increased risk of thrombosis related to third generation pills. This led many women coming off the pill, resulting in 12,400 additional births and a 9% abortions rise in 1996.

Overall, the odds of having a thrombotic episode related to the pill are very low, in particular with combined pills containing low dose of estrogen (30 or less micrograms) and old-generation progesterone (such as levonorgestrel).

The minipill, also known as the progestin-only birth control pill, is a form of oral contraception that does not contain estrogen, and its progestin dose is lower than that in the combined formulation. Although its efficacy is slightly reduced as compared to the combined pill, the minipill does not increase the risk of venous thromboembolism or arterial thrombotic accidents (see below).

5) The pill increases the risk of heart attack and stroke

TRUE. An extensive review study looking at arterial vascular accidents attributed to the pill (myocardial infarction and ischemic stroke) showed that the overall risk of arterial thrombosis was 60% increased in women using oral contraceptive pills compared to non-users. Unlike venous thrombosis, the risk did not vary according to the type of synthetic progesterone. However, it was twice as high in women taking pills with higher doses of estrogen (the older formulations of contraceptive pills).

Therefore, the combined pill containing levonorgestrel and low dose estrogen (no more than 30 µg) is the safest oral form of hormonal contraception. The minipill may also be considered in high risk women (see above).

6) A woman should not take the pill if she smokes

TRUE. There is some evidence that smoking may decrease the effectiveness of hormonal birth control. When taking the pill, smokers experience more frequently irregular bleeding than non-smokers; this could signal that the efficacy of the pill is lowered, but more research needs to be conducted to better understand the effect of smoking on the pill’s action.

But what we do know for sure is that smokers who take combined oral contraceptives have increased risk of venous thrombosis and heart disease (see above). This risk is higher for women that smoke more than 15 cigarettes/day, are older than 35 years old or take formulations with high estrogen levels.

If you are under 35 years old and smoke, you should be extremely careful about using the pill, and the decision to take it should be individualized considering other risk factors such as personal and familiar history of high blood pressure, high cholesterol or heart disease. Smokers aged 35 or over should not take the combined contraceptive pill.

If you smoke you may opt for the mini pill, which does not seem to increase the risk of venous thromboembolism or arterial thrombotic accidents; otherwise you should discuss with your doctor about another contraceptive method, such as the intra-uterine device (IUD).

7) The pill causes mood changes and depression

DEBATABLE. Most studies have shown no effect of the pill on depression and mood changes; some studies have even found a protective effect. In 2016, an extensive review on hormonal contraception and mood changes confirmed the existing evidence, and concluded that “… negative mood changes are infrequent and combined hormonal contraception may be prescribed with confidence”.

However, a recent publication came to challenge this assertion. Danish researchers went through the health records of more than a million women using hormonal contraception. They found that those on the combined pill were 23% more likely to be prescribed an antidepressant than those not on hormonal contraception. For those on the minipill (and on other progesterone-only methods, including the hormonal IUD), the figure rose to 34%. It increased even further, to 80% more likely, for girls 15 to 19 years old on the combined pill.

There are a few important points to consider about these results:

Depression is a complex condition whose cause is still poorly understood. Several factors seem to play a role: genetic, environmental, psychological and social. Therefore, it is very difficult to evaluate the link between depression and hormonal contraception.
The Danish study does not prove that hormones are responsible for the depression – “association” does not necessarily translate into “causation”.
The risk of being diagnosed with depression peaks at two to three months of contraceptive use, but then begins to fall.
Even if these findings are confirmed, the number of affected women remains small: 2.2 out of 100 women who use hormonal birth control develop depression, compared to 1.7 out of 100 non-users.

In conclusion, the pill may have impact on some women’s emotions, but further research is needed to establish whether hormonal contraceptives are indeed the cause of depression and mood changes.

8) The pill is 100% reliable

FALSE. Theoretically, with perfect use, the pill is 99.7% effective at preventing unwanted pregnancy. However, there are many factors that may interfere with the pill’s level of effectiveness: forgetting to take it, not taking it as directed, certain medications or medical problems…Therefore, when it comes to real life, the pill is about 92% effective: about 8 in 100 women using the combined pill will get pregnant in a year.

In any case, the birth control pill remains one of the most reliable contraceptive methods.

9) If you take the pill you don’t need the condom

FALSE. A survey conducted in France showed that “…one in ten young women 15 to 20 years old is not aware that the pill does not protect against HIV and sexually transmitted infections (STI)”. As stated before, the pill is a very good at preventing unwanted pregnancy but it offers no STI protection at all. In fact, the only contraceptive method that protects against sexually transmitted infections is the condom. Read more here.

10) The pill causes cancer

TRUE AND FALSE. The pill seems to increase the risk of certain cancers, but it protects again others. Overall, with the use of oral contraceptives the risk of endometrial and ovarian cancer is reduced, whereas the risk of breast and cervical cancer appears to be increased.

The protective effect on ovarian and endometrial cancer (the lining of the uterus) has been consistently demonstrated in many studies. This effect increases with the length of time oral contraceptives are used and continues for many years after a woman stops using the pill.

Long-term use of oral contraceptives is associated with an increased risk of cervical cancer. This correlation is not completely understood, as virtually all cervical cancers are caused by certain types of human papillomavirus (HPV). It has been suggested that women who use the pill may be less likely to use condoms, therefore increasing their risk of being exposed to HPV.

An extensive analysis of more than 70 studies suggested an increased risk of breast cancer among current and recent users of hormonal contraception. The risk was highest for women who started using oral contraceptives as teenagers. However, by 10 years after cessation of use, their risk was similar to that in women who had never used it.

Since most studies so far have evaluated birth control pill older formulations with higher doses of hormones, until recently it was assumed that the newer-generation pills available now would be safer regarding breast cancer risk. Yet a new study from Denmark found that even with the current pills, hormonal contraception users experienced a 20% increase in the risk of breast cancer compared to non-users; the odds rose among women who used hormones for more than 10 years. The risk was similar in magnitude to that of older pill types.

Whether oral contraceptive use increases the risk of liver cancer is not clear: while some studies found more cases of hepatocellular carcinoma ( a type of liver cancer) in women who took the pill for more than 5 years, others did not confirm this correlation.

Hormonal contraception seems to have a protective effect on colo-rectal (bowel) cancer, but this has not been yet consistently proven.

Since the pill seems to reduce the frequency of certain cancers and increase the risk of others, an interesting question arises: Does the pill increase the overall risk of cancer? The answer is NO. A recently published study provided epidemiological data on more than 40,000 women followed for more than 40 years. The results showed that users of oral contraceptives are protected from colo-rectal, endometrial, and ovarian cancer; this beneficial effect lasts for many years after stopping the pill. An increased breast and cervical cancer risk was seen in current and recent users, which appears to be lost within approximately 5 years of stopping oral contraception, with no evidence of either cancer recurring at increased risk in ever users with time. These results are reassuring and provide strong evidence that most women do not expose themselves to long-term cancer harm if they choose to use oral contraception; indeed, many are likely to be protected.

11) The pill has many bothersome side effects

TRUE AND FALSE. Some women refuse to take the pill because they fear certain annoying symptoms. Indeed, the birth control pill is a medication, and as such, it has possible side effects.

The most common adverse reactions associated with use of combined contraceptives include changes in bleeding patterns, nausea, breast tenderness, headaches, missed periods, vaginal discharge and visual changes with contact lenses; few women may also experience changes in sexual desire and mood changes, or temporary weight gain related to fluid retention (see above). In general, these side effects are not a sign of illness, and usually stop within the first few months of using the pill.

While some women may experience bothersome symptoms, the pill provides important non-contraceptive health benefits:

Decreased risk of certain cancers (see above)
Improved bone mineral density (in older women)
Protection against pelvic inflammatory disease
Prevention of ovarian cysts
Reduction of menstrual bleeding problems
Prevention of menstrual migraines (with non-stop formulations)
Protection against iron-deficiency anemia
Reduction of ovulation pain
Treatment of acne
Treatment of bleeding from fibroids
Treatment of dysmenorrhea (painful periods)
Treatment of excess hair on face or body
Treatment of premenstrual syndrome (PMS)
Reduction of endometriosis symptoms
Reduction of polycystic ovarian syndrome symptoms
Induction of amenorrhea for lifestyle considerations (when you need to stop your period for a while; you can also advance or delay your period with the pill)

So, how dangerous is the pill?

There is no perfect contraception method. I wish there were. And it is true that hormonal contraception, like any other medication, may have annoying side effects and serious health risks. Does it mean that no one should take the pill? Of course not!

We should keep in mind that severe risks are very rare and most bothersome symptoms are short-lived; in addition, the pill offers many non-contraceptive health benefits. But when discussing about the pill’s pros and cons, sometimes we forget a very important issue: the birth control pill is one of the most effective contraceptive methods. And effective birth control prevents from unwanted pregnancy, which may have not only devastating psychological consequences, but may also lead to severe physical harm.

Therefore, the potential problems of the birth control pill should be analyzed in perspective: we shouldn’t just pay attention to downsides, forgetting to place them in context with the upsides. Every woman considering taking the pill should thoroughly discuss with her healthcare provider not only the possible risks, but also its significant benefits, which for many women will be greater than the harms.

Photo credits

Heading: vintag.es; 1: thebump.com; 2: breakingmuscle.com; 3: thejewel.com; 4: health.harvard.edu; 5: newhealthadvisor.com; 6: pinterest.com; 7: pinterest.com; 8: pinterest.com; 9: blog.path.org; 10: purelyb.com; 11: buzzfeed.com; Conclusion: bigthink.com

29Mar2016

CONTRACEPTION: 14 COMMON MYTHS – BUSTED

Posted in Health by woman2womenblog

How good is your knowledge on contraception? Statistics show that even if contraception awareness is on the rise, there are still a lot of important gaps, and many misconceptions persist.

If you are like most young people, your “education” on birth control comes mainly from your friends, and the internet. And you may have learnt valuable things from them! But there is still a lot of misinformation going around, leading in many cases to misunderstandings and unpleasant surprises…

Following are some of the most common myths, rumours and misperceptions regarding birth control that you should know in order to avoid an unplanned pregnancy.

MYTH # 1: I won’t get pregnant if my partner pulls out before he comes

This is one of the most common misconceptions, responsible for many unwanted pregnancies. Also known as the withdrawal method, it has a high rate of contraception failure. This is because some pre-ejaculation fluid (or pre-come) may be released before the man actually ejaculates; this pre-come contains spermatozoids, and it takes only one sperm to get you pregnant! In addition, some men may not have enough self control to withdraw in time…

Keep in mind that pre-ejaculation fluid can also contain sexually transmitted infections, so pulling out will not prevent you from getting an infection.

MYTH # 2: I don’t get pregnant if I have sex during my period

The chances of getting pregnant while on your period are low, but it may happen, mainly in women with shorter cycle –i.e., if you get your period every 21-24 days. In such case, your ovulation occurs around the 10^th to 12^th day after the beginning of your period. Since sperm can live up to 5 days inside your body, if you have sex towards the end of your period, sperm can wait for the egg to be released and you may become pregnant.

But even in women with longer, regular cycles, the ovulation may eventually take place earlier… So remember, you can get pregnant at any time of the month if you have sex without contraception.

MYTH # 3: The morning after pill is dangerous, you can’t take it more than once or twice in your lifetime

It has been suggested (mostly by internet rumours) that it is dangerous to take the emergency contraception pill more than one or twice in your life. According to the World Health Organisation: “Emergency contraceptive pills are for emergency use only and are not appropriate for regular use as an ongoing contraceptive method because of the higher possibility of failure compared with non-emergency contraceptives. In addition, frequent use of emergency contraception can result in side-effects such as menstrual irregularities, although their repeated use poses no known health risks.” Emergency contraception pills are very safe and do not harm future fertility. Side effects are uncommon and generally mild. Read more about the morning after pill here.

MYTH # 4. I don’t get pregnant if I have sex standing up or if I’m on top

Some women believe that having sex in certain positions, such as standing up, sitting down, or if they jump up and down afterwards, they won’t get pregnant as sperm will be forced out of the vagina. In fact, sperm are very strong swimmers! It has been showed that within 5 minutes, sperm are able to reach the tube, where the fertilisation of the egg takes place, and this happens regardless of the position you have sex in.

There’s no such thing as a “safe” position if you’re having sex without a condom or another form of contraception. There are also no “safe” places to have sex, including the bathtub, the shower or the sea.

MYTH # 5. There are only 3 contraceptive options: the condom, the pill and the IUD

Although these three methods are the best-known, there are 15 different methods of contraception (the available options differ in each country). Unfortunately -for women- there are only two choices for men (the male condom and permanent sterilisation). Women have a choice of about 13 methods, including several of long-acting reversible contraception -this means you don’t need to remember to take it or use it every day or every time you have sex.

MYTH # 6. The IUD is not suitable for teenagers and women without children

In the USA, 44% of adolescent girls ages 15 to 19 have had sexual intercourse. Although most of them have used contraception, teenagers frequently use methods with high failure rates -such as withdrawal, or they incorrectly use more reliable methods -such as the pill. In fact, 8 out of every 10 adolescent pregnancies are unintended.

The intrauterine device (IUD), a small device that is inserted into the uterus, has been traditionally reserved to women who have had children. However, new guidelines issued by the American College of Obstetricians and Gynecologists have changed this old perception: the IUD, together with the contraceptive implant, are considered now first-line contraceptive options for sexually active adolescents and young women, as they are the most effective reversible contraceptives for preventing unintended pregnancy, with about 99% effectiveness.

Of course, the IUD and the implant do not protect against sexually transmitted infections, therefore you should also use condoms for that purpose.

MYTH # 7. You can’t get pregnant if it’s the first time you have sex, or if you don’t have an orgasm

These persistent misconceptions are, unfortunately, still responsible for many unplanned pregnancies. If the intercourse takes place during your fertile period, you may become pregnant, whether it’s the first or the hundredth time you’ve had sex, whether you liked it or not.

MYTH # 8. Two condoms are better than one

Condoms may occasionally break. Many people think that using two condoms (also known as “double bagging”) is safer than using one. Actually, it’s exactly the opposite: using two condoms causes friction between them, increasing the risk of breakage. Thus, two condoms should not be used, neither for pregnancy prevention or for safer sex; this is also true for using a male and a female condom at the same time. When used properly, a male condom is 98% effective at preventing pregnancy, a female condom is 95% effective.

MYTH # 9. I can use any lubricant together with the condom

During intercourse, adding lubricant may ease penetration, so sex is pleasurable and not painful. This is important when, for many reasons (such as stress, medications, taking the pill, etc) the natural wetness of the genital area is reduced.

Lubricants can be made from water, oil, petroleum or silicone; however, when using condoms, water-based lubricants should be used: oil-based products such as petroleum jelly, creams, or baby oil and can damage the latex and make the condom more likely to split, resulting in no contraceptive protection.

Silicone-based lubricants are a newer form of lubrication; they are safe to use with condoms. However, they can be harder to wash off and may cause irritation.

MYTH # 10. If you take the pill for many years, you won’t be able to have children in the future

This is another very common misconception. After stopping the oral contraceptive pill you may get pregnant immediately, but sometimes it may take two or three cycles for your fertility to fully return, no matter how long you have been using it. Some studies have shown that, within a year after going off the pill, 80% of women trying to get pregnant will get pregnant – exactly like women who were never on the pill.

MYTH #11. You don’t get pregnant if you douche right after sex

Vaginal douching (washing out the vagina) after sex won’t help to prevent a pregnancy. Again, this has to do with spermatozoa being fast swimmers. By the time a woman starts douching, sperm are already well inside the uterine cervix, where no douching solution can reach them.

In fact, you should never douche: douching can lead to many health problems, including problems getting pregnant, vaginal infections and sexually transmitted infections.

MYTH #12. I’m breastfeeding so I can’t get pregnant

While you’re less fertile when breastfeeding, you may become pregnant; there is no accurate way to predict when fertility returns, even if you breastfeed exclusively. You may not menstruate for several months after giving birth, but at some point you will have your first ovulation -where you can get pregnant- and this will occur two weeks before you get your first period.

Thus, when nursing you should use birth control if you wish to avoid pregnancy.

MYTH # 13. You’re only fertile one day a month

If you have a regular cycle of 28 days, the ovulation usually occurs the 14^th day of your cycle. But it’s not only that day that you are fertile. As said before, sperm can live in the cervix for up to 5 days, waiting for the egg to be released. Studies have shown that most pregnancies result from intercourse that takes place during a six-day period ending on the day of ovulation. Once the egg leaves the ovary, in about 24 hours it dies, and the fertile period is over.

However, even in women with a perfectly regular cycle, the hormonal balance involved in the ovulation process can be disrupted by many factors: stress, medications, etc, leading to an earlier or delayed ovulation. Thus, trying to avoid a pregnancy by just having intercourse on the “safe” days can be difficult and may eventually result in an unwanted pregnancy.

MYTH # 14. I don’t need a condom because I’m taking the pill

A survey conducted in France showed that “…one in ten young women ages 15 to 20 is not aware that the pill does not protect against HIV and sexually transmitted infections”. In fact, the only contraceptive method that offers protection against STIs is the condom. Even other barrier methods, such as the diaphragm, do not to keep bacteria out of the vagina, and the pill and IUD offer no STI protection at all.

The bottom line:

Don’t be afraid to talk to a doctor about birth control! True, discussing contraception and sexual practices with a healthcare professional may be embarrassing… but it’s better to discuss ways to prevent an unintended pregnancy rather than dealing with one after it happened!

You can do your research before scheduling an appointment -there are many good sites to learn useful information about birth control – but a doctor will help you decide which is the best contraceptive method for you, and how to use it in a proper way.

Knowledge is empowerment! Learn your choices, be aware of the dangers of irresponsible sexual practices, be the advocate for your own sexual health!

Find out more about contraception here:

Centers for Disease Control and Prevention, USA. Contraception

National Health System, UK. Your contraception Guide

FPA UK. My contraception tool

Photo credits

Intro: evoke.ie; 1: your-life.com; 2: aboutgettingpregnant.com; 3: keepcalm-o-matic.co.uk; 4: pinterest.com; 5: xonecole.com; 6: teenplaybook.org; 7: geekandjock.com; 8: contraception.about.com; 9: hackcrow.com; 10: telegraph.co.uk; 11: aliexpress.com; 12: fidias.net; 13: dailymail.co.uk; 14: blog.path.org; bottom line: contraception-about.com.

13Jun2015

EGG FREEZING: IS IT FOR ME?

Posted in Health by woman2womenblog

Ann is 36 years old, she is single and hasn’t met “Mr. Right” yet… She feels her biological clock is ticking, and is afraid of not finding the right partner in time to have children.

Marie, age 35, is an executive employee at a big multinational company. Although she would like to have a family, she believes that motherhood at this time will affect her career.

Both of them are wondering the same thing: Should I freeze my eggs?

Egg freezing, also called oocyte cryopreservation, has been around for many years now. But lately it has been extensively discussed in the media, especially since Facebook and Apple announced that they will be paying egg freezing for their female employees (read more here).

You have most likely heard of egg freezing, but how is the procedure? Is it safe? When to do it? Is it a sure thing?

In this article we will clarify the most important aspects of egg freezing and discuss some realities you need to know in case you decide to embark on this venture…

What is egg freezing? Why should I consider it?

Egg freezing means that a woman’s eggs are extracted from the ovaries, frozen and stored for future use.

Fertility declines with age, and this is due to ageing of the ovaries and eggs (oocytes). Unlike men, who produce spermatozoa throughout most of their lifetime, woman are born with a lifetime’s egg supply: we have about 2 million immature eggs at birth, when we reach puberty there are about 300.000 left, and each month we lose several thousands. By the time we are 30 years old, 90% of the eggs are already gone, and only 3% have remained when we reach 40.

But it’s not only quantity that matters, it’s also quality. As the body ages, the oocytes age as well, and their genetic material may become damaged. This is the reason why older women have reduced fertility, but also increased risk of pregnancy loss and having a baby with certain defects such as Down syndrome.

Unlike the eggs, the uterus is not affected by ageing and is able to carry a pregnancy in the 40s and beyond; this is true even for menopausal women.

Therefore, if we pick up the eggs and freeze them, eggs’ quality will remain unaltered with time: let’s say you freeze your eggs at 30 years old, and you put them back in your 40s, your eggs will still be 30 years old!

Who are the candidates for egg freezing?

–Women who want to delay motherhood for social reasons, usually due to career or study obligations, or because they are not in a stable relationship. This is the most common reason egg freezing is requested and carried out, although scientific societies’ opinions worldwide are divided in this matter. While the European Society for Human Reproduction and Embryology (ESHRE) endorses it by stating: “Oocyte cryopreservation should […] be available for women […] who want to protect their reproductive potential against the threat of time”, the American Society for Reproductive Medicine (ASRM) stands more cautious, concluding: “There are not yet sufficient data to recommend oocyte cryopreservation for the sole purpose of circumventing reproductive aging”.

Although social egg freezing will be the focus of this article, there are other situations where egg freezing is, beyond any doubt, an invaluable tool:

–Women diagnosed with certain cancers. Some cancer treatments such as chemotherapy, radiotherapy or surgery may damage the ovaries, leading to sterility. Thus, freezing the eggs before therapy may preserve fertility in these women.

–Women with high risk of going into early menopause:

women carrying a faulty gene or chromosome known to cause early menopause;
those with a strong family history of early menopause.
those having a defective gene (such as BRCA1 and 2 genes) related to high risk of ovarian cancer, when removal of the ovaries is considered. In such women, if childbearing has not been completed, egg freezing may be an option before surgery.

–Certain couples undergoing in vitro fertilization (IVF):

When for religious or legal reasons the embryos cannot be frozen. This is a common situation in countries such as Italy, where embryo freezing is forbidden by law.
If the man is unable to collect sperm, or when men with severe infertility do not have no sufficient spermatozoa to fertilize all available eggs. In such cases, the eggs can be frozen for use at a later date.

How is the procedure I should go through to freeze my eggs?

In order to freeze the oocytes, a woman undergoes a hormonal treatment, aimed to stimulate the ovaries to produce multiple eggs. There are several protocols for that -the so-called short and long protocols- depending on ovarian function and also how urgent the procedure is (e.g. when egg freezing is done before cancer treatment).

Initially, a medication is used to turn off natural hormones, sometimes together with birth control pills. After that, hormone injections are self-administered during 10 to 14 days to mature the eggs.

When the eggs are ripe, they are aspirated through the vagina with the aid of a needle, under ultrasound guidance. The procedure is usually done under mild sedation. The eggs are immediately frozen, in most centers with a method called vitrification.

Once a woman decides to attempt pregnancy -this may be months or years later- the oocytes are thawed, injected with a single spermatozoon and left in an incubator to fertilize. After two to five days, the resulting embryos are transferred into the uterus with a thin catheter.

It should be mentioned that some women from whom few eggs are retrieved may need to undergo several stimulation cycles in order to have a reasonable number of oocytes cryopreserved (the ideal number would be 20 to 30).

Age issues…

What is the ideal age to freeze my eggs?

From the biological point of view, the answer is straightforward: the younger, the better. Here is why: a woman in her 20s is expected to have 15 to 25 eggs available for freezing. Since the oocytes are of good quality, about 4 to 5 eggs will be needed to produce one baby (some eggs will not survive the thawing process and others will not fertilize). Someone in her 40s, though, will produce in the best of the cases 8 to 10 eggs, but (statistically speaking) 25 eggs may be needed to produce one baby, because the eggs will be of lower quality…

But at what age should a woman take the decision to freeze her eggs? This question is more difficult to answer. Ovarian function is not equal for every woman. While certain women in their early 30s have already diminished ovarian function, others in their 40s have excellent hormonal levels… An ideal time frame would be between 30 and 35, but again, we should be cautious as this may not apply to every woman.

In order to help you decide when to freeze your eggs, some experts suggest to monitor regularly the ovarian reserve by measuring a hormone called Anti Mullerian Hormone (AMH), which is very reliable to show how the ovaries work.

What is the age limit to freeze my eggs?

According to ESHRE, cryopreservation for women older than 38 should not be recommended, unless prior assessment of the ovarian reserve justifies the procedure. In many centers, the upper limit is 43, because this is the age when pregnancy rates drop dramatically. Again, there may be exceptions according to a woman’s ovarian function.

What is the age limit to use my frozen eggs?

As stated above, the uterus is not affected by ageing. There have been reports of women having children -with egg donation from a younger woman- in their 60s. But there is a point where a pregnancy will not benefit neither the woman, nor the children. The ASRM advises against embryo transfer (either fresh or frozen) in women over 55, because over that age the maternal and fetal risks seem to be higher. Many centers set the limit of 50, which is the age limit established by law in many countries.

How well does egg freezing work?

Out of all the frozen eggs, about 90-95% will survive the thawing process. When the thawed eggs are fertilized, the results are comparable to those with IVF using fresh oocytes: 36 to 65% pregnancy rate, according to different studies. Like with IVF, success rates are clearly linked to maternal age at the time of freezing, the younger the women, the higher the pregnancy rates.

These results, although impressive, show that egg freezing is not a 100% guarantee of success; of all women freezing their eggs about half of them will become pregnant.

How long can the eggs remain frozen?

Egg freezing is a relatively recent procedure, but the practice of freezing embryos has been around for many years, and pregnancies have been achieved with embryos frozen for more than 20 years. So we expect that, most likely, the same will apply to frozen eggs.

Is it a safe procedure?…

…For the woman?

Obtaining oocytes for fertility preservation is a very safe procedure, although not entirely without risk of complications. The medications taken to stimulate the ovaries, the procedure of egg pick-up and the anesthesia required are all possible sources of complications. Briefly, the medications’ side effects are usually mild, as one of the most feared complications in assisted reproduction, the ovarian hyperstimulation syndrome, is very rare (this is because the embryo transfer is deferred). The remaining risks are estimated as follows: risks from the anesthesia: in 1/10.000; risk of severe hemorrhage from the egg retrieval procedure: 1/2.500; risk of infection: less than 1/500. For a more detailed analysis of complications, check here.

…For the baby?

To date, more than 5.000 babies have been born from frozen eggs, and the available data seem to be reassuring. The largest study on this subject analyzed 900 babies; no increased rate of birth defects was observed. Of course, since this is a relatively new procedure, it will take many years of follow-up to confirm egg freezing safety.

Unanswered questions…

There are still many controversial issues and debate surrounding egg freezing; from women feeling egg freezing is “as liberating as the contraceptive pill”, to those believing this is just a -very lucrative- business, pushing women to consider “a must” to freeze their eggs and to feel “irresponsible” if they don’t do it. This debate has been even more fuelled by Apple and Facebook’s decision to pay the procedure to their employees…

At the present time, some questions remain to be answered:

Will egg freezing become a standard procedure, a sort of insurance each woman will have?
Will it push women to become mothers at a later age, leading to a generation of older parents?
Is egg freezing the future of fertility? Will this procedure contribute to medicalize conception?
Can we / should we fool our biological clock?
Will companies force women to devote their lives to their jobs, to eventually “discard” them in their 50s? Should women’s efforts be directed towards achieving more benefits for working mothers, rather than getting egg freezing payed?
What will happen to all the frozen, unused eggs?
What are the psychological risks of the procedure, especially for women who froze their eggs but did not become pregnant?

The bottom line…

Egg freezing is not a warrant for future pregnancy. Delaying childbearing you may risk missing the opportunity to eventually have a child.
This procedure should be regarded as a “plan B”: an emergency measure in case you fear you won’t be able to have children before running out of eggs.
Before deciding to freeze your eggs, you should discuss extensively the procedure with your doctor, in order to learn risks and chances of success in your particular case.
What is more important, all women should be aware that there is an age-related fertility decline in women. Therefore, when possible, you should not delay childbearing. The biological clock does tick!

More info at gofertile.eu