TRYING TO GET PREGNANT: 14 FERTILITY MYTHS DEBUNKED

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

EGG DONATION IN GREECE: ALL YOU NEED TO KNOW


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

ΚΑΤΑΨΥΞΗ ΩΑΡΙΩΝ: ΝΑ ΤΗΝ ΚΑΝΩ Η ΟΧΙ;

Η Άννα είναι 36 ετών, είναι ελεύθερη και ακόμα δεν έχει βρει τον κατάλληλο σύντροφο. Αισθάνεται ότι το βιολογικό της ρολόι “χτυπάει”, και φοβάται να μην προλάβει να κάνει παιδιά.

Η Μαρία, 35 ετών, είναι διοικητικός στέλεχος σε μια μεγάλη πολυεθνική εταιρεία. Παρά το γεγονός ότι θα ήθελε να έχει μια οικογένεια, πιστεύει πως η μητρότητα αυτή τη στιγμή θα επηρεάσει την καριέρα της.

Και οι δύο γυναίκες αναρωτιούνται το ίδιο: Μήπως να παγώσω τα ωάριά μου;

Η κατάψυξη ωαρίων, ή κρυοσυντήρηση ωαρίων, έχει ξεκινήσει εδώ και αρκετά χρόνια. Αλλά τον τελευταίο καιρό έχει συζητηθεί εκτενώς από τα μέσα ενημέρωσης, ειδικά από τότε που οι εταιρίες Facebook και Apple ανακοίνωσαν πως θα πληρώνουν την κατάψυξη ωαρίων για τις γυναίκες υπαλλήλους τους (διάβασε περισσότερα εδώ).

Πιθανόν να έχεις ακούσει για την κατάψυξη ωαρίων, αλλά πώς είναι η διαδικασία; Είναι ασφαλής; Πότε την κάνουμε; Είναι εγγυημένο το αποτέλεσμα;

Σε αυτό το άρθρο θα περιγράψουμε τη διαδικασία της κατάψυξης ωαρίων και θα συζητήσουμε κάποιες “πραγματικότητες” που πρέπει να γνωρίζεις σε περίπτωση που αποφασίσεις να προχωρήσεις σε αυτό το εγχείρημα…

 

Τι είναι η κατάψυξη ωαρίων; Πώς γίνεται;

egg freezing human-eggΚατάψυξη ωαρίων σημαίνει ότι τα ωάρια μιας γυναίκας εξάγονται από τις ωοθήκες, καταψύχονται και αποθηκεύονται για μελλοντική χρήση.

Είναι γνωστό πως η γυναικεία γονιμότητα μειώνεται με την ηλικία, και αυτό οφείλεται στη γήρανση των ωοθηκών και των ωαρίων. Σε αντίθεση με τους άνδρες, οι οποίοι παράγουν σπερματοζωάρια κατά το μεγαλύτερο μέρος της ζωής τους, οι γυναίκες γεννιόμαστε ήδη με όλα μας τα ωάρια: έχουμε περίπου 2.000.000 ανώριμα ωάρια στη γέννηση, όταν φτάσουμε στην εφηβεία μένουν περίπου 300.000 και κάθε μήνα χάνουμε αρκετές χιλιάδες. Στα 30 μας έτη το 90% των ωαρίων έχει ήδη φύγει, και μόνο το 3% παραμένει στα 40.

Αλλά δεν είναι μόνο η ποσότητα που έχει σημασία, είναι και η ποιότητα. Καθώς το σώμα γερνάει, γερνάνε και τα ωάρια, το τι σημαίνει ότι το γενετικό τους υλικό μπορεί να αλλοιωθεί. Αυτός είναι ο λόγος που οι γυναίκες μεγαλύτερης ηλικίας έχουν μειωμένη γονιμότητα, αλλά και αυξημένο κίνδυνο αποβολών και να αποκτήσουν ένα μωρό με ορισμένα προβλήματα όπως το σύνδρομο Down.

Σε αντίθεση με τα ωάρια, η μήτρα δεν επηρεάζεται από τη γήρανση και μπορεί υποστηρίξει μια εγκυμοσύνη, ακόμα και στα 50 έτη. Αυτό ισχύει και για γυναίκες σε εμμηνόπαυση.

Συνεπώς, αν παίρνουμε τα ωάρια μιας γυναίκας και τα παγώνουμε, η ποιότητα των ωαρίων θα παραμείνει αμετάβλητη με το χρόνο: ας πούμε ότι παγώνεις τα ωάριά σου όταν είσαι 30 ετών, και τα χρησιμοποιείς στα 40 σου, τα ωάρια θα εξακολουθήσουν να είναι 30 χρονών!

 

Σε ποιες γυναίκες απευθύνεται η κατάψυξη ωαρίων;

Egg freezing beautiful-business-woman-looking-what-time-is-it

Γυναίκες που θέλουν να καθυστερήσουν τη μητρότητα για κοινωνικούς λόγους:

συνήθως λόγω εκπαιδευτικών ή επαγγελματικών υποχρεώσεων, ή επειδή δεν είναι σε μια σταθερή σχέση. Αυτός είναι ο πιο συχνός λόγος που οι γυναίκες ζητάνε και πραγματοποιούν την κατάψυξη ωαρίων, αν και οι απόψεις των επιστημονικών εταιρειών διίστανται πάνω σε αυτό το θέμα. Ενώ η Ευρωπαϊκή Εταιρεία Ανθρώπινης Αναπαραγωγής και Εμβρυολογίας (ESHRE) την υποστηρίζει, δηλώνοντας: «η κρυοσυντήρηση ωαρίων θα πρέπει […] να είναι διαθέσιμη και για τις γυναίκες […] που θέλουν να προστατεύσουν τον αναπαραγωγικό τους δυναμικό κατά της απειλής του χρόνου», η Αμερικανική Εταιρεία Αναπαραγωγικής Ιατρικής (ASRM) είναι πιο επιφυλακτική, και συμπεράνει: «Δεν υπάρχουν ακόμα επαρκή στοιχεία που να συνιστούν την κρυοσυντήρηση ωαρίων με μοναδικό σκοπό την παράκαμψη της αναπαραγωγικής γήρανσης».

Αν και η κατάψυξη ωαρίων για κοινωνικούς λόγους (“social egg freezing”) θα είναι το επίκεντρο αυτού του άρθρου, υπάρχουν και άλλες περιπτώσεις στις οποίες η κατάψυξη ωαρίων είναι, πέρα ​​από κάθε αμφιβολία, ανεκτίμητης αξίας:

Γυναίκες που έχουν διαγνωστεί με ορισμένους καρκίνους.

Μερικές θεραπείες για τον καρκίνο, όπως χημειοθεραπεία, ακτινοθεραπεία ή κάποιες χειρουργικές επεμβάσεις μπορεί να βλάψουν τις ωοθήκες και να οδηγούν σε στειρότητα. Ως εκ τούτου, το πάγωμα των ωαρίων πριν από τη θεραπεία μπορεί να διατηρήσει τη γονιμότητα σε αυτές τις γυναίκες.

Γυναίκες με υψηλό κίνδυνο πρόωρης εμμηνόπαυσης:

  • γυναίκες που έχουν ένα ελαττωματικό γονίδιο ή χρωμόσωμα που είναι γνωστό ότι προκαλούν πρόωρη εμμηνόπαυση,
  • άτομα με ισχυρό οικογενειακό ιστορικό πρόωρης εμμηνόπαυσης.
  • γυναίκες με ένα ελαττωματικό γονίδιο (όπως BRCA1 και 2) που σχετίζονται με υψηλό κίνδυνο καρκίνου των ωοθηκών, όταν κρίνεται αναγκαία η αφαίρεση των ωοθηκών. Σε αυτές τις γυναίκες, αν η τεκνοποίηση δεν έχει ολοκληρωθεί, η κατάψυξη ωαρίων μπορεί να είναι μια επιλογή πριν από την επέμβαση.

Ορισμένα ζευγάρια που υποβάλλονται σε εξωσωματική γονιμοποίηση (IVF):

  • Όταν για θρησκευτικούς ή νομικούς λόγους, δεν δύναται να καταψυχθούν τα έμβρυα. Αυτό ισχύει και για χώρες όπως η Ιταλία, όπου η κατάψυξη εμβρύων απαγορεύεται από το νόμο.
  • Αν ο άνδρας αδυνατεί να συλλέγει σπέρμα, ή όταν άνδρες με σοβαρή υπογονιμότητα δεν έχουν επαρκή αριθμό σπερματοζωαρίων να γονιμοποιήσουν όλες τα διαθέσιμα ωάρια. Σε τέτοιες περιπτώσεις, τα ωάρια μπορούν να καταψυχθούν για χρήση σε μεταγενέστερη ημερομηνία.

 

Πώς είναι η διαδικασία που θα πρέπει να ακολουθήσω για να παγώσω τα ωάριά μου;

egg freezing woman-giving-herself-ovarian-stimulation-injection

Για να γίνει η κατάψυξη ωαρίων, η γυναίκα θα πρέπει να υποβάλλεται σε μια ορμονική θεραπεία, με στόχο να διεγείρει τις ωοθήκες να παράγουν πολλαπλά ωάρια. Υπάρχουν διάφορα πρωτόκολλα για αυτό -τα λεγόμενα βραχύ και μακρύ πρωτόκολλα- ανάλογα με την ωοθηκική λειτουργία και το πόσο επείγουσα είναι η διαδικασία (π.χ. όταν η κατάψυξη ωαρίων γίνεται πριν από τη θεραπεία του καρκίνου).

Αρχικά, χορηγείται ένα φάρμακο για την αναστολή των φυσικών ορμονών της γυναίκας, μερικές φορές σε συνδυασμό με αντισυλληπτικά χάπια. Στη συνέχεια, ακολουθείται μια ορμονική θεραπεία σε ενέσιμη μορφή -οι ενέσεις συνήθως τις κάνει η ίδια η γυναίκα- για 10 έως 14 ημέρες μέχρι να ωριμάσουν τα ωάρια.

Όταν τα ωάρια είναι ώριμα, αναρροφούνται με μια βελόνα διαμέσου του κόλπου, με υπερηχογραφική καθοδήγηση. Η διαδικασία γίνεται συνήθως κάτω από ήπια αναισθησία (“μέθη”). Τα αυγά καταψύχονται αμέσως, στα περισσότερα κέντρα με τη μέθοδο της υαλοποίησης.

Μόλις η γυναίκα αποφασίσει να προσπαθήσει να μείνει έγκυος -αυτό μπορεί να είναι μήνες ή χρόνια αργότερα- τα ωάρια αποψύχονται, εγχέονται με ένα σπερματοζωάριο και αφήνονται σε έναν επωαστήρα να γονιμοποιηθούν. Μετά από δύο έως πέντε ημέρες, τα προκύπτοντα έμβρυα μεταφέρονται στη μήτρα με ένα λεπτό καθετήρα.

Θα πρέπει να αναφερθεί ότι κάποιες γυναίκες που έχουν λίγα ωάρια μπορεί να χρειαστεί να υποβληθούν σε πολλούς κύκλους διέγερσης, προκειμένου να έχουν έναν καλό αριθμό κατεψυγμένων ωαρίων (ο ιδανικός αριθμός είναι περίπου 20 – 30).

 

Ηλικιακά ζητήματα …

Ποια είναι η ιδανική ηλικία για να παγώσω τα ωάριά μου;

Egg freezing woman on clock resized 2Από βιολογική απόψη, η απάντηση είναι απλή: όσο νεότερη, τόσο καλύτερα. Και αυτό για τον εξής λόγο: μια γυναίκα στα 20 της αναμένεται να έχει 15 με 25 ωάρια για κατάψυξη. Δεδομένου ότι τα ωάρια είναι καλής ποιότητας, θα χρειαστούν περίπου 4-5 ωάρια για να αποκτήσει ένα μωρό (μερικά δεν θα επιβιώσουν τη διαδικασία της απόψυξης, άλλα δεν θα γονιμοποιηθούν και άλλα θα παράγουν ανώμαλα έμβρυα). Μια γυναίκα 40 ετών, όμως, θα έχει στην καλύτερη των περιπτώσεων 8-10 ωάρια, ενώ μπορεί να χρειαστούν 25 ωάρια για να προκύπτει μια εγκυμοσύνη, επειδή τα ωάρια είναι κατώτερης ποιότητας…

Αλλά σε ποια ηλικία θα πρέπει μια γυναίκα να πάρει την απόφαση να παγώσει τα ωάριά της; Αυτό το ερώτημα είναι πολύ πιο δύσκολο να απαντηθεί. Η λειτουργία των ωοθηκών δεν είναι ίδια για κάθε γυναίκα. Ενώ ορισμένες γυναίκες 30 χρονών έχουν ήδη μειωμένη ωοθηκική λειτουργία, άλλες στα 40 τους έχουν εξαιρετικά ορμονικά επίπεδα … Ένα ιδανικό χρονικό πλαίσιο θα ήταν μεταξύ 30 και 35 χρονών, αλλά και πάλι, θα πρέπει να είμαστε προσεκτικοί καθώς αυτό μπορεί να μην ισχύει για όλες τις γυναίκες.

Ως οδηγός για το πότε θα πρέπει μια γυναίκα να παγώσει τα ωάριά της, μερικοί ειδικοί προτείνουν να μετρηθεί τακτικά μια ορμόνη στο αίμα που ονομάζεται Anti Mullerian Hormone (ΑΜΗ), η οποία είναι πολύ αξιόπιστη για να δείξει πώς λειτουργούν οι ωοθήκες και πως είναι το “απόθεμα” τους.

Ποιο είναι το ανώτερο όριο ηλικίας για να παγώσω τα ωάριά μου;

Σύμφωνα με την ESHRE, η κρυοσυντήρηση για γυναίκες άνω των 38 ετών δεν θα πρέπει να συνιστάται, εκτός εάν η εκτίμηση του ωοθηκικού αποθέματος δικαιολογεί την διαδικασία. Σε πολλά κέντρα εξωσωματικής γονιμοποίησης, το ανώτατο όριο είναι τα 43 έτη, γιατί σε αυτή την ηλικία τα ποσοστά εγκυμοσύνης μειώνονται δραματικά. Και πάλι, μπορεί να υπάρχουν εξαιρέσεις ανάλογα με την ωοθηκική λειτουργία κάθε γυναίκας.

Ποιο είναι το ανώτερο όριο ηλικίας για να χρησιμοποιήσω των παγωμένα ωάρια;

Egg freezing New York magazine

Όπως αναφέρθηκε πριν, η μήτρα “δεν γερνάει”. Υπάρχουν αναφορές για γυναίκες που έχουν γεννήσει ένα παιδί -με δωρεά ωαρίων από νεότερη γυναίκα- στα 60 τους. Αλλά υπάρχει ένα όριο όπου η εγκυμοσύνη δεν θα ωφελήσει ούτε τη γυναίκα, ούτε το παιδί της. Η ASRM συμβουλεύει κατά την εμβρυομεταφορά σε γυναίκες άνω των 55 ετών, επειδή πάνω από αυτή την ηλικία υπάρχει μεγαλύτερος κίνδυνος για τη γυναίκα και για το έμβρυο. Πολλά κέντρα στο εξωτερικό θέτουν ως όριο τα 50 έτη.  Στην Ελλάδα, βάση νόμου, το όριο ηλικίας για έμβρυο μεταφορά, είτε με φρέσκα ή με κατεψυγμένα ωάρια είναι 50 ετών.

 

Πόσο αποτελεσματική είναι η κατάψυξη ωαρίων;

Pregnant Heart

Από όλα τα κατεψυγμένα ωάρια, περίπου το 90-95% θα επιβιώσει την διαδικασία της απόψυξης. Όταν αυτά τα ωάρια γονιμοποιούνται, τα αποτελέσματα είναι συγκρίσιμα με εκείνα της εξωσωματικής γονιμοποίησης χρησιμοποιώντας φρέσκα ωάρια: 36-65% ποσοστό εγκυμοσύνης, ανάλογα με διάφορες μελέτες. Όπως και με την εξωσωματική γονιμοποίηση, τα ποσοστά επιτυχίας είναι καθαρά συνδεδεμένα με την ηλικία της μητέρας τη στιγμή της κατάψυξης: όσο νεότερη η γυναίκα, τόσο υψηλότερο το ποσοστό εγκυμοσύνης.

Τα αποτελέσματα αυτά, αν και εντυπωσιακά, δείχνουν ότι η κατάψυξη ωαρίων δεν είναι μια εγγύηση 100% επιτυχίας: από όλες τις γυναίκες που παγώνουν τα ωάριά τους, περίπου οι μισές από αυτές θα μείνουν έγκυες.

 

Πόσο καιρό μπορεί τα ωάρια να παραμένουν κατεψυγμένα;

Egg freezing liquid-nitrogen

Η κατάψυξη ωαρίων είναι μια σχετικά πρόσφατη διαδικασία, αλλά η πρακτική της κατάψυξης εμβρύων γίνεται εδώ και πολλά χρόνια, και έχουν επιτευχθεί εγκυμοσύνες με έμβρυα που ήταν κατεψυγμένα για περισσότερο από 20 χρόνια. Γι ‘αυτό αναμένουμε ότι, κατά πάσα πιθανότητα, το ίδιο θα ισχύει και για τα κατεψυγμένα ωάρια.

 

Είναι η κατάψυξη ωαρίων ασφαλής…

… Για τη γυναίκα;

Egg freezing petri dish

Η κατάψυξη ωαρίων είναι μια πολύ ασφαλής διαδικασία, αν και όχι εντελώς ακίνδυνη. Τα φάρμακα που λαμβάνονται για τη διέγερση των ωοθηκών, η αναρρόφηση των ωαρίων και η αναισθησία που απαιτείται είναι πιθανές πηγές επιπλοκών. Εν συντομία, οι παρενέργειες των φαρμάκων είναι συνήθως ήπιες, καθώς μία από τις πιο επίφοβες επιπλοκές στην υποβοηθούμενη αναπαραγωγή, το σύνδρομο υπερδιέγερσης των ωοθηκών, είναι πολύ σπάνιο (επειδή η εμβρυομεταφορά γίνεται σε δεύτερο χρόνο). Οι υπόλοιποι κίνδυνοι εκτιμώνται ως εξής: κίνδυνοι από την αναισθησία: 1 / 10.000, κίνδυνος σοβαρής αιμορραγίας από τη ωοληψία: 1 / 2.500, κίνδυνο μόλυνσης: λιγότερο από 1/500. Για μια πιο λεπτομερής ανάλυση των επιπλοκών, διάβασε εδώ.

… Για το μωρό;

Egg freezing baby

Μέχρι σήμερα, περισσότερα από 5.000 παιδιά έχουν γεννηθεί από κατεψυγμένα ωάρια, και τα διαθέσιμα δεδομένα φαίνεται να είναι καθησυχαστικά. Στη μεγαλύτερη μελέτη μέχρι στιγμής σε αυτό το θέμα παρακολούθησαν 900 μωρά, και το ποσοστό γενετικών ανωμαλιών ήταν ίδιο σε σχέση με το γενικό πληθυσμό. Φυσικά, δεδομένου ότι η κατάψυξη ωαρίων είναι μια σχετικά πρόσφατη διαδικασία, θα χρειαστούν πολλά χρόνια παρακολούθησης για την επιβεβαίωση της ασφάλειάς της.

 

Αναπάντητα ερωτήματα …

Egg freezing Woman holding clock

Υπάρχουν ακόμα πολλά αμφιλεγόμενα ζητήματα γύρω από την κατάψυξη ωαρίων: κάποιες γυναίκες πιστεύουν πως είναι “επαναστατική και απελευθερωτική, όπως το αντισυλληπτικό χάπι”, άλλες θεωρούν ότι είναι απλώς μέρος μιας κερδοφόρας επιχείρησης, που προσπαθεί να πείσει τις γυναίκες ότι επιβάλλεται να παγώσουν τα ωάρια τους και ότι είναι “ανεύθυνο” να μην το κάνουν. Η απόφαση των εταιριών Apple και Facebook να πληρώσουν αυτή τη διαδικασία στις υπαλλήλους τους “φούντωσε” ακόμα περισσότερο τη διαμάχη…

Προς το παρόν, παραμένουν ορισμένα ερωτήματα να απαντηθούν:

• Θα γίνει η κατάψυξη ωαρίων μια διαδικασία ρουτίνας, ένα είδος “ασφάλειας” που θα έχει κάθε γυναίκα;

• Θα ωθήσει τις γυναίκες να γίνονται μητέρες σε μεγαλύτερη ηλικία, με αποτέλεσμα να δημιουργήσει μια γενιά ηλικιωμένων γονέων;

• Είναι η κατάψυξη ωαρίων το μέλλον της γονιμότητας; Θα συμβάλει στην “ιατρικοποίηση” της διαδικασίας σύλληψης;

• Μπορούμε  / Επιτρέπεται να ξεγελάσουμε το βιολογικό μας ρολόι;

• Μήπως η μεγάλες εταιρείες θα αναγκάζουν τις γυναίκες να αφιερώσουν τη ζωή τους στην δουλειά τους, για να τις «ξεφορτωθούν» στα 50 τους; Μήπως οι προσπάθειες των γυναικών θα πρέπει να επικεντρωθούν περισσότερο στην επίτευξη μεγαλύτερων προνομίων για τις εργαζόμενες μητέρες, παρά στο να τους πληρώσουν την κατάψυξη ωαρίων;

• Τι θα συμβεί με όλα τα κατεψυγμένα, αχρησιμοποίητα ωάρια;

• Ποιες είναι οι ψυχολογικές επιπτώσεις της κατάψυξης ωαρίων, ιδίως στις γυναίκες που πάγωσαν τα ωάριά τους, αλλά τελικά η διαδικασία απέτυχε και δεν μείνανε έγκυες;

 

Συμπεράσματα…

  • Η κατάψυξη ωαρίων δεν είναι εγγύηση για μια μελλοντική εγκυμοσύνη. Αν καθυστερείς την τεκνοποίηση υπάρχει ενδεχόμενο να χάσεις την ευκαιρία να κάνεις ένα παιδί.
  • Η διαδικασία αυτή θα πρέπει να θεωρηθεί ως το «σχέδιο Β»: ένα μέτρο έκτακτης ανάγκης σε περίπτωση που φοβάσαι ότι δεν θα είσαι σε θέση να κάνεις παιδιά πριν σου τελειώσουν τα ωάρια.
  • Προτού αποφασίσεις να παγώσεις τα ωάριά σου, θα πρέπει να συζητήσεις εκτενώς τη διαδικασία με έναν εξειδικευμένο επαγγελματία, προκειμένου να μάθεις τους κινδύνους και τις πιθανότητες επιτυχίας στη συγκεκριμένη περίπτωσή σου.
  • Και το βασικότερο από όλα, είναι πολύ σημαντικό να γνωρίζεις ότι στις γυναίκες, όσο μεγαλώνουμε, μειώνεται η γονιμότητα. Συνεπώς, εφόσον είναι δυνατόν, δεν θα πρέπει να καθυστερήσεις την τεκνοποίηση. Το βιολογικό μας ρολόι πράγματι χτυπά!

More info at gofertile.eu

Βιβλιογραφία

The American College of Obstetricians and Gynecologists: Oocyte Cryopreservation. Committee Opinion, Number 584 -January 2014

ESHRE Task Force on Ethics and Law: Oocyte cryopreservation for age-related fertility loss. Hum Reprod. 2012 May;27(5):1231-7.

Practice Committees of American Society for Reproductive Medicine; Society for Assisted Reproductive Technology. Mature oocyte cryopreservation: a guideline. Fertil Steril. 2013 Jan;99(1):37-43.

Cobo A1, Diaz C. Clinical application of oocyte vitrification: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril. 2011 Aug;96(2):277-85.

Egg Freezing for a Future Pregnancy: What to Know. WebMD

Φωτογραφίες

Intro: Getty images; oocyte: scitechdaily.com; career woman: youqueen.com; hormone injection: fssc.com.au; intra cytoplasmic sperm injection: Wellcome images, Flickr.com; ideal age: Tatyana A, Flickr.com; age limit to use frozen eggs ffemagazine.com; pregnant heart: Olivier Martins, Flickr.com; Egg freezing: midlandfertility.com; safety for the woman: theage.com.au; for the baby: Daniel James, Flickr.com; unanswered questions: Stefano Corso, Flickr.com; young pregnant woman: Tips Times Admin, Flickr.com.

 

EGG FREEZING: IS IT FOR ME?

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 human-eggEgg 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?

Egg freezing beautiful-business-woman-looking-what-time-is-itWomen 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?

egg freezing woman-giving-herself-ovarian-stimulation-injectionIn 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?

Egg freezing woman on clock resized 2

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?

Egg freezing New York magazineAs 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?

Pregnant HeartOut 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 liquid-nitrogenEgg 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?

Egg freezing petri dishObtaining 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?

Egg freezing babyTo 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…

Egg freezing Woman holding clockThere 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

References:

The American College of Obstetricians and Gynecologists: Oocyte Cryopreservation. Committee Opinion, Number 584 -January 2014

ESHRE Task Force on Ethics and Law: Oocyte cryopreservation for age-related fertility loss. Hum Reprod. 2012 May;27(5):1231-7.

Practice Committees of American Society for Reproductive Medicine; Society for Assisted Reproductive Technology. Mature oocyte cryopreservation: a guideline. Fertil Steril. 2013 Jan;99(1):37-43.

Cobo A1, Diaz C. Clinical application of oocyte vitrification: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril. 2011 Aug;96(2):277-85.

Egg Freezing for a Future Pregnancy: What to Know. WebMD

Photo credits

Intro: Getty images; oocyte: scitechdaily.com; career woman: youqueen.com; hormone injection: fssc.com.au; intra cytoplasmic sperm injection: Wellcome images, Flickr.com; ideal age: Tatyana A, Flickr.com; age limit to use frozen eggs ffemagazine.com; pregnant heart: Olivier Martins, Flickr.com; Egg freezing: midlandfertility.com; safety for the woman: theage.com.au; for the baby: Daniel James, Flickr.com; unanswered questions: Stefano Corso, Flickr.com; young pregnant woman: Tips Times Admin, Flickr.com.