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Egg cells freezing
Egg cells freezing are a procedure where egg cells are removed from the ovaries, frozen and stored to be used later in life when a woman wishes to become pregnant.
The reason for planning a later pregnancy can be medical and social (when a woman wants to postpone pregnancy due to private plans).
When a woman wants to get pregnant, the egg cells are thawed and an in vitro fertilization procedure is performed.
In the in vitro fertilization procedure, ICSI is always used with thawed egg cells.
When are egg cells frozen?
Eggs are frozen:
- Before therapy with cytostatics and radiation in malignant and immunological diseases;
- For social and personal reasons when a woman does not have a partner or wants to postpone pregnancy and childbirth;
- In cell donation program - when women donating egg cells freeze their egg cells in banks of reproductive material;
-During in vitro fertilization process when, for medical or personal reasons, the partner does not have spermatozoa.
The process of freezing egg cells in the Gyn-Fertility Clinic Milenković
Physiologically, every month in women of reproductive age, one egg cell is released during the ovulation process.
When the egg cell freezing procedure is performed, the ovaries are stimulated with gonadotropic hormones that are secreted by the pituitary gland, in order to obtain as many mature egg cells as possible for freezing.
The stimulation process is the same as in the stimulation process for in vitro fertilization (IVF). A long (agonist) or short (antagonist) protocol can be used.
Freezing of egg cells at Gyn. Fertility Clinic Milenković is done in cooperation with Special Gynecology Hospital Jevremova Belgrade.
Preparation and consultations are performed at the Clinic, while aspiration and freezing of embryos are performed at the Special Gynecology Hospital Jevremova Belgrade.
- A woman comes to the Clinic for the first consultation. Then a detailed interview is conducted and a gynecological and ultrasound examination is performed.
- During the ultrasound examination, the uterus and ovaries are analyzed, where the number of antral follicles, which reflect the ovarian reserve, are determined.
The following blood serum analyses are also performed:
- anti-Müllerian hormone (AMH) which shows the ovarian reserve;
- thyrostimulating hormone (TSH);
- analysis of blood serum for hepatitis B, hepatitis C, HIV and syphilis.
The course of the procedure, expected results and potential complications are explained to the patient in detail.
After that, a procedure plan is made, the dose of the drug for stimulation.
After determining the therapy, the patient talks to the nurse who explains how the therapy is administered and agrees on the organizational details.
- Long protocol lasts for 25-30 days, and short about 15 days. In the long protocol, the function of the ovaries is first "blocked " with drugs , and then the ovaries are stimulated with hormones, while in the short protocol, stimulation is first started, and then the ovaries are "blocked". Ovarian function is blocked to prevent premature ovulation.
- Short stimulation protocol is most often applied in the process of freezing egg cells and hormonal stimulation begins on the second or third day of the menstrual cycle, while the antagonist drug (ovarian blocker) is given a few days later.
Stimulation can be started on any day of the cycle when the egg cells freezing procedure is performed with the aim of preserving fertility in women suffering from malignant diseases.
- Stimulation drugs are in the form of injections that are administered under the skin and women usually self-administer the drugs.
- During the stimulation, two to three ultrasound examinations are performed, where the growth of the follicle and thus the indirect maturation of the egg cell are monitored.
- The egg cell is 0.1 mm and cannot be seen by ultrasound examination. Sometimes an analysis of estradiol from the blood serum is also performed.
- Stimulation ends with a "stop" injection, the function of which is to release the egg cell from the follicle wall. Stop injection is given when we have at least two-three follicles of 17-18 mm, but the assessment is individual in relation to the number of follicles, age and the result of any previous stimulation. The patient is given an injection of human choriogonadotropic hormone (hCG) to stimulate ovulation.
- In situations where there is a risk of ovarian hyperstimulation syndrome, alternative injections from the group of gonadotropic releasing hormone (GnRH) agonists are used.
- Aspiration of egg cells is done 34-36 hours after the stop injection.
- When aspiration is performed under short-term general anesthesia, an examination by a specialist in internal medicine, confirmation of the blood type and a blood count (Le, Er, Tr, Hb, HCt) are required.
- When aspiration is performed under local anesthesia, a blood type is required.
- Patients do not take food or water for six to eight hours before the egg cells aspiration, regardless of whether it is done under general or local anesthesia.
- It is necessary to remove nail polish and come without jewelry.
Sexual intercourses are not advised in the period from the stop injection to the transfer due to the risk of multiple pregnancies in the case of premature or subsequent ovulation after egg aspiration.
- The patient comes to the hospital an hour before the planned intervention and settles in the patient room. After that, she goes to the operating room for aspiration of the cells.
- After receiving anesthesia, the vagina is treated with saline solution. Sterile protection and an accessory through which the aspiration needle passes are placed on the vaginal probe of the ultrasound device. The needle is connected to a pump that extracts fluid from the follicle.
- Under ultrasound control, a needle is inserted into the ovary, that is, into each individual follicle, and thus extracts fluid from the follicle. Egg cells are found in the liquid.
- The resulting fluid is immediately given to embryologists who identify the egg cells. After the aspiration, the patient returns to the room and stays in the hospital for another two hours.
- Fifteen to twenty minutes after the aspiration, the doctor who performed the intervention comes to the patient's room and informs her about the number of eggs obtained. A few hours after the aspiration, the patient receives information on how many egg cells are frozen.
- Female patients receive painkillers. Pain similar to menstrual pain is most often felt.
- An antibiotic is given during aspiration when there is some risk factor for infection.
- Menstrual bleeding usually occurs 5-10 days after egg aspiration.
Success of the procedure - pregnancies resulting from the use of frozen cells
Women who freeze 15 eggs before the age of 35 have an 85% chance of getting pregnant, while the chance with 15 eggs is about 40% when the woman is older than 36 at the time of freezing.
The chance of pregnancy decreases with the age of a woman, especially after the age of 40.
Pregnancies in women whose eggs cells were frozen at the age of 43 have also been described. Only mature egg cells that are in the stage of the second meiotic division (MII) are frozen. 5-20% of egg cells do not survive thawing and therefore the goal is to get as many egg cells as possible to maximize the chance of pregnancy.
Expert advice: frequently asked questions
Answers by: Milan Milenković, MD, PhD
How to prepare for the first consultation?
It is preferable for a woman to have anti-Muller (AMH) and thyrostimulating hormone (TSH) tests at the first consultation. If a decision is made to freeze egg cells, serological analyzes of blood serum for hepatitis B, hepatitis C and syphilis, as well as smears for sexually transmitted diseases, are performed.
How long does the egg freezing procedure take?
The egg freezing procedure takes about 14 days when using the short protocol and about 4 weeks when using the long protocol.
How to behave after the egg freezing procedure? Is it necessary to rest?
The patient can return to normal activities after the egg cells freezing procedure. Heavy physical activities are not advised, but neither is absolute rest. Light physical training can be started a day or two after egg cells aspiration. Swimming does not increase the risk of complications. Sudden movements and jumping are not advised.
The patient can drive a car and travel by plane. If the flight is longer than 6 hours and the patient is traveling within two weeks after aspiration, therapy with low molecular weight heparin (fraxiparin) is advised before the trip. The usual diet that the patient had before the procedure is recommended.
Sexual intercourses are not advised in the period from the stop injection to two days after aspiration due to the risk of multiple pregnancies in case of premature or subsequent ovulation after egg aspiration.
When can the egg freezing procedure be repeated?
When eggs are frozen for medical a reason, which is most often before treatment for malignant diseases, a new procedure can be repeated immediately after aspiration. Otherwise, the procedure is most often repeated 2-3 months after the previous one, depending on how many eggs were obtained, age and private situation.
What is the price of the egg freezing procedure at the Milenković Clinic?
See the price of the egg freezing procedure in our price list which is updated regularly.
What are the side effects of drugs in the stimulation process?
In the first days of stimulation in a short protocol, there are usually no side effects. At the end of the stimulation, patients may feel fatigue, sleepiness, bloating of the chest and stomach, and headache. Sometimes there is redness at the injection site after the injection of drugs that block the function of the ovaries. All these unwanted effects disappear after stopping the therapy.
The patient has no unwanted effects at the beginning of therapy in the long protocol. After a few days of GnRH agonist therapy, the patient may have symptoms similar to those of menopause, since the ovaries stop producing estrogen. These can be heart palpitations, insomnia, dry skin and hair, mood swings and headaches. The symptoms disappear after the start of stimulation with FSH/LH hormones. In the first days of stimulation with hormones, there are generally no unwanted effects, while at the end of the stimulation, the same effects of the drugs as in the short protocol may occur. The discomforts disappear after stopping the therapy.
How many times can egg cells freezing be done?
The egg cells freezing procedure can be done several times and how many times it will be done depends on the age of the patient, the obtained egg cells and the patient's private plans. In any case, the assessment is individual.
Is the egg freezing procedure available at the Gyn-Fertility Clinic Milenković at the expense of the state?
The Gyn-Fertility Clinic Milenković performs egg cell freezing, which is financed by the Republic Health Insurance Fund (RFZO), of the Republic of Serbia, in women suffering from malignant, rheumatic and genetic diseases. It is necessary that the woman on the commission chooses the Special Gynecology Hospital Jevremova in Belgrade.
What are the complications of the egg cells freezing procedure?
The risk of bleeding and infection after egg cells aspiration is less than 1%. Hyperstimulation syndrome or OHSS from ovarian hyperstimulation syndrome occurs today in less than 1% of women after hormonal stimulation in the egg cells freezing procedure. In women who freeze egg cells and there is a minimal risk for OHSS, Decapapetil from the group of GnRH agonists is given as a stop injection instead of hCG), which significantly reduces the risk for OHSS.
Do stimulant drugs increase the risk of cancer?
Medicines used for stimulation do not increase the risk of developing cancer. These are the same drugs that are used in the IVF procedure, and no epidemiological study has shown that IVF increases the risk of either cancer or any other disease.
Is pregnancy after using frozen egg cells risky?
Pregnancy occurs when the egg cells are thawed and fertilized with the partner's or donor's spermatozoa. After thawing, the procedure continues in the same way as the IVF process.
IVF has a slightly increased risk for pregnancy complications.
Is there an increased risk for anomalies in children when frozen egg cells are used?
Children born after IVF where they were used frozen egg cells do not have an increased risk for developmental anomalies.
When is the best time to freeze egg cells?
The results are best when the eggs are frozen before the age of 35. A significant number of women do not use their egg cells, since they achieve a spontaneous pregnancy. The assessment of egg cell freezing is individual and is made after a detailed analysis.
