Summary

Egg-freezing is a process in which a woman who does not want to conceive a child immediately can opt to have her eggs extracted, frozen and preserved in a cold-storage, for future use. At a later time in life, when she is ready to have a child, the eggs can be retrieved, thawed, and fertilized in the woman’s womb, or outside the womb in a lab (in vitro) in order to conceive and deliver the child. It offers several benefits to women who are not ready, or suitable for childbirth, due to various reasons. Governments worldwide are encouraging the trend by formulating friendly policies in this regard.

Introduction

Many of us reading this article are from a generation where it was normal for girls to get married in their early or mid-20s. Parents and the society at large would often warn her about the perils of marrying late. One such reason, which is technically valid, is that a woman’s fertility starts dropping off with age. Eggs are non-renewable resource and most women are born with a finite number of them. Over time and age, the number and quality of eggs start declining. As a result, women who conceive after 35 years of age are at higher risk of miscarriages and bearing children with genetic defects. Bearing children after 45 years of age becomes almost impossible, even if menopause is years away.

Society has come a long way since then, and especially in the last 3 decades. Today, more and more women who are educated are seeking to have a life-long career and be financially independent at all times. In the process, marriage and childbirth become low priority. And then there are some unfortunate women who are trapped in unhappy marriages, and may not want to start a family with the existing partner. Finally, marriages are no longer seen by women as a ticket to a good life, and many are choosing to stay single.

At the same time, the biological clock for all these women is ticking away. Those desiring to start a family must make quick decisions. Previously, such women had no option but to try their luck at conception at a later day, and if that didn’t work out – to adopt a child. Today, egg-freezing provides them an excellent alternative.

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What is Egg-Freezing

The medical term for egg-freezing is oocyte cryopreservation (oocyte meaning egg and cryo meaning sub-zero temperatures). As the name implies, in this procedure, the woman’s eggs are harvested, frozen quickly, and then preserved in a cold-storage on a long-term basis. Whenever the woman is prepared to bear a child, the frozen eggs are retrieved, fertilized by sperm provided by the partner in a laboratory (called in-vitro fertilization or IVF), one of the fertilized embryos is carefully selected and that is implanted in the woman’s uterus. Thereafter, she can go through pregnancy and childbirth, as usual.

Although the first instance of egg-freezing happened in the 1980s, in the West, it’s still a new trend in India. Actresses Priyanka Chopra and Riddhima Pandit, and businesswoman Upasana Kamineni who have chosen this option have brought this trend into the limelight.

Reasons for Egg-Freezing

There are umpteen reasons why women may want to freeze their eggs, to be used later. These can be classified under medical reasons and social reasons.

Medical

• Is suffering from cancer and has to undergo treatments such as radiation or chemotherapy. Such treatments can hurt her fertility and reduce the chances of conception.
• The woman suffers from PCOS (polycystic ovarian syndrome), endometriosis (where uterine tissue starts growing outside the uterus), diabetes, hypertension, fibroids or pelvic inflammatory disease. All of these affect the quality of eggs and the chances of having a healthy pregnancy followed by a safe childbirth.
• The woman is having difficulty in conceiving and has chosen IVF. In this case, there is no choice, and egg-freezing is part of the process.
• The woman wants to preserve high-quality eggs, harvested from her at a young age, to be used later. (Incidentally, a man can do the same with his sperm as the same story plays out here as well).
• There is a family history of early menopause.
• Either she, or the male partner, or both have genetic defects and want to reduce the risk of not being able to conceive at a later date, by harvesting eggs at a young age.

Social

• The woman has plans to study, work longer before taking a break for pregnancy, or travel, and must delay childbirth.
• The family is financially unstable now, and would like to start a family when things are better.
• The partners have other expenses or is busy with a parent’s health issue, or purchasing of a new home. So, it’s not a suitable time to start a family.
• The woman is in an abusive marriage and is staring at the possibility of divorce. The timeframe may not be clear now, so egg-freezing is the ideal Plan B.
• The woman has just lost her partner to untimely death.
• The male partner has fertility issues, so the family is not decided on whether to adopt a child, or use sperm from a donor bank. In this case, the woman can choose to freezer her eggs now till the decision-making is completed.
• The woman is in a long-distance marriage with the partner based out of a distant city or country.
• The woman is member of the LGBTQ community and does not want to go through the normal routine of marriage, pregnancy and childbirth.
• The woman works in a high-stress job which comes with the risk of fertility issues.

How does the entire process work

• Ovarian reserve testing: On day 3 of the menstrual cycle, a blood-test is done to measure the levels of FSH and estradiol hormones to assess the quantity and quality of eggs. This will determine how efficiently the ovaries will react to fertility drugs.
• Next, more blood tests and an ultrasound of the ovaries is done to obtain a complete picture of ovarian function.
• Thereafter, the woman is screened for infectious diseases like HIV and hepatitis (B and C).
• The ovaries are hyper-stimulated using hormones and drugs. This increases the number of eggs that can be produced by the ovaries.
• Eggs are extracted using needle aspiration, in an operation that lasts 10-minutes and performed under local anaesthesia.
• After extraction, the eggs are examined. The best or most healthy ones are vitrified, or flash-frozen quickly (as slow freezing can destroy them). The frozen eggs are kept at a temperature of -196 degrees centigrade in liquid nitrogen to prevent any drop in their quality with time. The freezers may be located in a fertility clinic, a long-term storage facility, a frozen egg bank, or a large hospital.
• When the woman wishes to conceive, the frozen eggs are retrieved from the freezer and defrosted using warming agents. The woman will be given drugs to prepare the uterine lining. Sperm taken from the partner or a donor are injected into the eggs to fertilise them. After five days of culturing in the same facility, the fertilized embryos are observed. The best or the most high-quality embryo is implanted into the woman’s uterus.
• The eggs or fertilized embryos can be stored indefinitely. However, in India, after 10 years, they must be either discarded, or donated for research, as per the mother’s wishes.

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Also Read: How much weight gain is normal during pregnancy?

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What is Surrogacy?

At this juncture, it is important to speak about surrogacy. In the process described above, the fertilized egg is inserted into the woman’s uterus after which she goes through the full term of pregnancy before delivering the child either naturally or through C-section. Now, women who cannot go through pregnancy for medical reasons, or do not want to go through the hassle of pregnancy and childbirth can engage a surrogate mother for this. Such mothers are healthy women from low-income families who are willing to rent out their womb for a fee. In this case, the fertilized egg is inserted into the surrogate’s uterus. After childbirth, the baby is handed over to the biological parents and the surrogate has no right over the same.

An example in case is actress Priyanka Chopra. At the age of 32, she chose to have her eggs frozen. At 36, she married, and at 39, she decided it was time to have a child. Considering her age and for other reasons, she decided to use a surrogate.

The combination of egg-freezing and surrogacy makes it an attractive option for disadvantaged or career-oriented women who cannot take the required breaks for pregnancy and childbirth. It also works out for women who have medical issues that make a full-term of pregnancy risky and childbirth fraught with complications. These two trends are expected to rise in the future.

What are the costs involved

The costs involved vary from hospital to hospital and includes:

• Initial consultation about the feasibility and process
• Screening tests, egg-harvesting, vitrification
• Storage for long-term (one-time and annual costs)

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

Chennai Alwarpet – 044 4000 6000 •  Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801

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