Egg freezing

Five main groups of women seek this reproductive service:

• Women who wish to have children at a later date. These women are aware that fertility declines with age and are choosing to undergo IVF treatment sooner, storing their eggs for the future.
• Women with cancer, as chemotherapy and radiation treatment can have a harmful effect on fertility, rendering many of these women menopausal.
• Women who are at risk of early menopause or have a genetic disorder that could limit fertility (e.g. Turner syndrome).
• Individuals or couples who, for religious or ethical reasons, are opposed to freezing embryos that result from IVF treatments and are more comfortable with storing unfertilised eggs instead.
• Couples who have no sperm retrievable on the day of their egg collection.

Other instances where egg freezing may be beneficial are:

• Donor cryo-banking – some women may wish to become “clinic-recruited donors” and donate their eggs for use by other couples undergoing IVF treatment.
• To allow synchronisation of donor and recipient cycle, although the most common practice, in this case, is to freeze embryos.

In egg freezing, a woman’s mature eggs are developed and removed using standard IVF techniques. This typically involves three stages of treatment: pituitary suppression, ovarian stimulation and egg retrieval.

Each of these treatments will be discussed in detail with your clinician. The egg retrieval itself is performed by an ultrasound-guided needle passed through the top of the vagina. The needle is passed into each follicle in the ovary and the fluid is withdrawn into a test tube. The fluid from each follicle is examined under a microscope and the eggs are collected for cryopreservation. The procedure will take only 20-30 minutes and is performed under sedation or anaesthetic. You will, therefore, be required to rest in the recovery room for about an hour afterwards.

You will also require monitoring with serial blood sampling and transvaginal ultrasonography during your cycle. It is common to experience some cramping and discomfort after egg retrieval as well as some vaginal spotting or bleeding. A heat pack, hot-water bottle or analgesic should be sufficient to manage the discomfort, but should the pain become severe or the bleeding heavy, please contact the clinic. You will need about two days off work.

As with all medications and medical procedures, side effects and potential risks are involved with all of the medications that may be received, and with egg-retrieval procedures. We encourage you to discuss these with your treating specialist.

The number of eggs retrieved in a single stimulation cycle is a very individual outcome. It depends greatly on your health, your age and how well you respond to the drug treatment. In addition, with human oocytes it is a case of “more is not necessarily better’’ with regards to egg numbers and quality.

With these factors in mind, your fertility specialist will tailor your drug/treatment cycle according to your specific requirements and/or previous responses.

Our ability to freeze any cell and have it survive depends on many factors. Because water expands in volume as it turns to ice, sperm cells must be dehydrated before freezing to prevent them from rupturing. The addition of a cryoprotectant, which does not expand upon freezing, can greatly reduce the risk of cell rupture.

Oocyte and embryo cryopreservation protocols, however, use a technique called “vitrification’’. Under this process, cooling rates are so rapid (more than 20,000C a minute) that ice does not have a chance to form, and the mixture of cryoprotectant and egg/embryo forms a glass-like structure. At City Fertility we routinely use vitrification as the preferred method of egg or embryo freezing.

For more information, please read our fact sheets: Egg freezing and storage fact sheet and Vitrification

The oocyte (egg) is the largest human cell and contains a high percentage of water. It is also sensitive and intolerant of the chemical and physical stresses created during freezing and thawing. When an oocyte is ovulated, or retrieved from the ovary during an IVF cycle, ideally it is ready to be fertilised by a single sperm. In anticipation of fertilisation, the oocyte prepares to discard half of its DNA in a process named meiosis. Any changes in the physical or chemical environment around the oocyte can disrupt meiosis, leading to an oocyte with too much or too little DNA. Hence, even after we overcome the hurdles of sensitivity and cell water content, these other obstacles to the successful freezing and thawing of oocytes remain.

While the overall aim of freezing is to help the egg survive upon thawing, certain damage or consequences of the procedure may not kill the cell but render it “less viable’’. A major issue is that eggs do not fertilise well after thawing. This is due to the partial disruption of the membrane, which causes a block to the conventional fusion and penetration of sperm with the egg surface. So, artificial forms of assisted insemination have to be used to achieve acceptable fertilisation outcomes with thawed eggs. This procedure is referred to as Intracytoplasmic Sperm Injection (ICSI) and is common in fertility centres worldwide. It involves the direct injection of a single sperm into an egg, thereby avoiding most of the usual barriers to fertilisation.

City Fertility follows egg storage guidelines recommended by the National Health and Medical Research Council (NHMRC Ethical Guidelines 2017). The maximum storage time at City Fertility is 10 years. After that time, if the eggs have not been used or donated to another couple and no alternative arrangements have been made, disposal will be arranged.

In Victoria, state legislation requires women wishing to extend the storage period of their eggs beyond 10 years to apply to the Patient Review Panel. The application to the Patient Review Panel must occur before the 10-year limit is reached. Please contact your clinic for advice on the process.

If your cryopreserved eggs are approaching the 10-year storage limit and you would like an extension, an application must be made, in writing, to the scientific director of City Fertility Centre. If you decide to dispose of your cryopreserved eggs stored at City Fertility Centre, please contact the fertility coordinator to discuss your options. Please note a signed disposal consent form is required before disposal can occur.

We ask all patients with cryopreserved eggs to keep City Fertility informed of any change to their contact details.

The first six months of storing eggs is complimentary.  After this period of time, storage is charged monthly via direct debit until either nil eggs/embryos remain or you decide to dispose of the remaining eggs/embryos.

We recommend that you see a City Fertility Centre Specialist to discuss your treatment options. Your specialist will determine whether the current Medicare legislation will classify you as medically or socially infertile. Medicare will only provide rebates for fertility treatment if you are deemed by your Specialist to be medically infertile. This will alter the out-of-pocket expenses of your treatment. Once your treatment plan has been individualised to your circumstances the patient services clinic staff will be able to provide you with a comprehensive quote tailored to your needs.

Please note the Australian Government is currently offering an Assisted Reproductive Technology (ART) Storage Funding Program, which assists patients who face extra costs for fertility treatment because of cancer or a genetic condition. This program aims to remove out-of-pocket costs for eligible cryostorage services for these patients. According to the program, the current funding amount is approximately $600 per year per type of material (eggs, sperm, or embryos), and patients can access funding for up to two types of material for up to 10 years.

Please contact our friendly team for further information about egg-freezing costs or to learn how to claim the ART Storage Funding Program rebate.  Call 1300 354 354 or email contactus@cityfertility.com.au.

For more information about egg freezing cost or to discuss the options available to you please contact our friendly staff.

The alternative approach of freezing an abundance of immature oocytes contained within ovarian tissue has been the subject of intensive research within the international IVF community over the past five to 10 years. For this process to be successful, the oocytes contained within the immature (primordial) follicles had to be able to survive freezing and go on to mature to a stage where they can be fertilised normally.

In the late 1990s the IVF community, having established optimal methods for ensuring that the follicles and immature oocytes in ovarian tissue could withstand storage at very low temperatures, began searching for ways to prove that these follicles and oocytes could undergo normal development to maturity. We now know this is possible. Using a technique whereby small samples of previously frozen tissue are grafted into a special type of laboratory mouse that cannot reject the graft (xenografting), scientists have been able to show that multiple mature follicles and oocytes are able to develop within the tissue frozen by this method. Importantly, we have also been able to show that this technique is reproducibly true for small samples of tissue frozen from a wide range of patients.

A number of groups worldwide have now started to take the first tentative steps towards applying this technology by grafting frozen/thawed tissue back to patients. Early reports of evidence of transient ovarian function after grafting provided only limited encouragement but more recently there have been further indications that ovarian function, and even fertility, may be reinstated through this method.

The potential disadvantage of using ovarian tissue harvested due to cancer is the theoretical possibility that these cancer cells will still be present in the ovarian tissue and may re-establish within the body once grafted.

Similar to the early days of IVF, this technology is still in its infancy but the potential benefits to a particularly vulnerable group of young women are enormous. Progress in assisting the ability to preserve future fertility will potentially have major implications for this group of women, both medically and socially.