As the average age of women at pregnancy increases, egg freezing has become an increasingly popular option. Dr. Ingrid Tavares Izzo , specialist in Assisted Reproduction at Vida and Gerar Vida, FERTGROUP units, clarifies doubts and discusses details of this procedure that has been sought after by many Brazilian women.
How does the egg freezing process work for someone who is starting this procedure, as you mentioned on social media?
Firstly, it is essential to have a medical consultation with prior investigation into fertility, assessment of it followed by clarification of the pros and cons individually for each patient, before deciding to freeze eggs. Once the decision is made, the patient begins hormonal stimulation of the ovaries, with daily hormonal injections, associated or not with oral medications, with the aim of stimulating the follicles initially recruited by the ovaries to grow and become dominant. This information is provided by ultrasound control during this first moment.
With a majority of dominant follicles, estimated by ultrasound, which can last an average of 11 days of subcutaneous injections, ovarian puncture is always performed under anesthesia. On the day the procedure is performed, we know how many eggs we can stimulate and collect. The eggs are evaluated for maturity, and the mature ones are then frozen.
You explained that in the egg freezing process, steps such as taking vitamins, taking tests and collecting the eggs are carried out. Can you share more about how these steps are conducted to ensure treatment success?
When egg freezing may be an option, the first step would be a consultation with an assisted reproduction specialist to assess fertility, based on blood tests such as anti-Mullerian hormone and hormonal levels, including assessments for pre-existing diseases. .
It is worth remembering that it is important to keep your gynecological routine up to date, in order to exclude diseases that need to be treated before starting egg freezing. From this we have a second stage, which includes vitamin supplements, and/or medications that are necessary, in order to make metabolic or hormonal adjustments, and also restrictions on alcohol or smoking, in an attempt to provide antioxidant actions, for a better quality of the collected eggs. This is because oxidative stress can somehow compromise, even if minimally, the quality of the eggs, as we know that the qualitative impacting factor is the age of the woman who is freezing.
After knowing the entire step-by-step process, the possible complications, advantages and expectations of the treatment, the third and final stage begins. In the first days of the menstrual cycle, the first ultrasound is performed to count the antral follicles , those recruited at the beginning of the menstrual cycle by the ovary and assessment for the absence of ovarian cysts, with the aim of a better cycle to be stimulated in an attempt to obtain better collection. of eggs within each patient’s expectations.
In the procedure you mentioned, which involves ovulation induction and egg collection, how is storage in liquid nitrogen conducted to ensure the best results?
After ovarian stimulation with subcutaneous hormonal injections, the ovarian follicles grow, mature and by aspiration of them with a needle via the vagina guided by ultrasound, under anesthesia, we can collect the eggs that moments before ovulation undergo a maturation process. These eggs, which have undergone a correct sequence of intrafollicular events , are called mature and will be subjected to cryopreservation, using the most widely used technique today that we call vitrification.
Vitrification is a form of ultra-rapid freezing, in which the eggs are “dehydrated” in the midst of cryoprotective substances to then be frozen and stored on a rod, rigorously identified and easily traceable, in liquid nitrogen at minus 196 degrees Celsius in tanks, more once rigorously checked and identified.
Regarding timing, you recommended that the treatment should ideally be carried out until the age of 35. How would you advise someone who is considering egg freezing in relation to their current age?
Ideally, egg freezing should be performed before the age of 35. This is because we know that from this age onwards, women’s fertility decreases, in other words, losing their quantitative potential to produce eggs and drastically worsening their quality. This biological clock ends up imposing a time for motherhood that does not correspond to the ideal time for many women.
Professional dedication, financial stability, or other projects mean that the subject of motherhood is increasingly postponed and even doubtful in some cases. Therefore, it is recommended to do it as soon as possible. The younger the egg is frozen, the greater the chances of pregnancy occurring when the patient decides to have children.
The IBGE survey shows a significant increase in the age of women who become pregnant in Brazil. How would you advise someone who is considering delaying motherhood until an older age?
Women who are thinking about postponing motherhood, or even those who have doubts about whether or not to have children, should consult with their gynecologist or a specialist in assisted reproduction, to assess fertility, including assessment of ovarian reserve and clarify the chances , risks, infertility factors, correlating age versus reproductive potential. The important thing is to decide to postpone or not have children after having clear and sufficient information for a conscious decision.
You mentioned that Brazilian women have been seeking fertility treatments around the age of 37. How do you suggest these women plan their fertility and make informed decisions about the right time to seek treatment?
As the average age at which women seek fertility treatments is 37 years old, the best way to plan and make decisions is to always consult with a specialist doctor so that he or she can investigate in a targeted manner, evaluate, guide and contribute to the better decisions, always together with patients, whether drawn up or initiated.
The importance of monitoring fertility during a woman’s check-up before the age of 30 was highlighted. How would you encourage someone to seek out information about their fertility options at a younger age?
We are increasingly aware that women have their biological clock and that professional life and female priorities have placed decisions regarding motherhood later and later. Therefore, knowledge and information about your fertility when we call it reproductive age helps so that changes in plans can be made. Having the possibility to plan, think about strategies, can make all the difference. Having information regarding fertility prevents opportunities from being missed. The most routine phrase we still hear during consultations is: “why didn’t they ask for these assessments beforehand”, “if I had known I would have frozen my eggs sooner or tried to get pregnant sooner”.
Within family planning, the importance of a perspective that encompasses financial organization is emphasized. How would you advise someone to consider the financial aspects when planning egg freezing?
Egg freezing is still expensive and we know that only a minority in the Brazilian reality would be able to afford the treatment costs. Proof of this is that, recently, news such as: “’In vitro’ fertilization and egg freezing are now being offered as benefits by multinational companies where treatments can be up to 100% covered”. Because of this, this decision also needs to be planned financially.
The sooner you acquire information about the treatment, the costs and the individual cost-benefit of each woman, the easier it will be to plan and decide on freezing. This way, it is possible to avoid emergency and unprepared actions that could be harmful and drastic to the patient’s financial health.
It is always worth remembering that freezing does not guarantee that pregnancy will come at the desired time, but it can increase the chances of motherhood happening at a time that she considers appropriate, if she cannot achieve it naturally. Therefore, talking about these chances versus the cost of treatment, versus financial planning are crucial when making a decision regarding whether or not to carry out freezing.
We cannot forget that the investment is high, it can bring the chance of a baby where the real chance would be very low. It is important to highlight that even after collection and freezing, there are cases in which it is necessary to carry out two or more stimulation cycles for a quantity of eggs that may be worthwhile in the future.
WIN research showed that relationships, lifestyle and financial issues were the main precursors to the decision to postpone motherhood until after the age of 35. How would you help someone make an informed decision about egg freezing, taking these factors into account?
It is always important to clarify the advantages and disadvantages of a proposed treatment. Egg freezing, indicated by the desire to postpone motherhood, is not exempt from this. An easy way to understand and that helps a lot in the decision, is to score the chances of a pregnancy in a woman before the age of 40 compared to the chances of a woman aged 40 or over. The disparity is enormous, reaching less than 5% using the in vitro fertilization technique at the age of 42.
Egg freezing offers the chance of pregnancy at the age at which it was frozen and this chance is indefinite. The patient would try, at an older age, to get pregnant with younger eggs and, therefore, with higher quality, offering a greater chance of pregnancy. And the best part: it does not accelerate the loss of egg supply through freezing. Throughout the female cycle that ovarian follicles are recruited, a single one matures and the rest are always lost, which is why the quantity is lost throughout life. At the time of stimulation for freezing, in that cycle, the follicles already recruited by the ovary will be stimulated and what we are trying to do is stimulate those that would already be wasted in a spontaneous cycle. Therefore, it does not interfere with the natural loss of ovarian stock. Therefore, we can never forget once again that the treatment does not guarantee pregnancy, but is a great opportunity to increase the chance of motherhood at the best moment decided by the patient, if she decides to have a child.
Finally, given your experiences so far and the information provided, what advice would you give to someone who is considering egg freezing as an option for the future?
The advice would be information as soon as possible. Seek information from experts in the field, talk to patients who have already gone through the decision-making moment and chosen freezing. Advantages, disadvantages, based on a good fertility assessment. This assessment can even apply to couples who are also thinking of postponing motherhood. It is important to know the fertility of the woman or the couple, so that planning or postponing the pregnancy can be substantiated, discussed and analyzed, even if after the exams and medical evaluation the conclusion is that the opportunity has passed and that there is no longer a cost-effectiveness relationship. advantageous benefit. The important thing is to try not to lose the opportunity for autonomy over a life project.
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