In this episode of PodMD, Fertility Specialist and Gynaecologist Dr Yousif Alyousif will be discussing the topic of Egg Freezing. We discuss what egg freezing is, how patients requiring egg freezing typically present, its risks and efficacy and more.
- Transcript
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*As always, all in this PodMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.
Today I’d like to welcome to the PodMd studio Dr Yousif Alyousif.
Dr Alyousif is a fertility specialist and consultant Gynaecologist and a Fellow of The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). His special interests include fertility, reproductive endocrinology, minimally invasive surgery, and ultrasound imaging.
Yousif completed his medical degree at the University of Otago in New Zealand, where he also undertook research in Reproductive Endocrinology. This sparked his interest in fertility and led him to pursue a Postgraduate Diploma in Obstetrics and Medical Gynaecology at the University of Otago, and a Masters of Reproductive Medicine with Excellence from the University of New South Wales.
Today, we’ll be discussing the topic of egg freezing.
*We do hope you enjoy this podcast but please remember that the advice here is of a general nature and is not intended as specific advice about a given patient. The views and opinions expressed in this podcast are those of the doctor, not PodMD. If you do have a patient on whom you require specific advice then please seek advice from a colleague with appropriate expertise in that area.
Yousif, thanks for talking with us on PodMD today.
Yousif: Thank you for having me.
The topic of today’s discussion is egg freezing. Yousif, can you describe for our listeners what egg freezing is?
Yousif: Certainly! So egg freezing, or as sometimes we like to call it Oocyte Cryopreservation, is a technique used to preserve a woman’s fertility by retrieving and freezing her eggs at a younger age so she can use them in the future. This is typically done using a process very similar to IVF, where we stimulate the ovaries with hormones to produce multiple eggs, then we collect them through a minor procedure under sedation. The eggs are then vitrified, which is fast freezing method to help preserve their quality in the long term. It does give women the option to defer childbearing due to either medical reasons, social reasons, or personal reasons, until they are ready to start a family.
Question 1
How would a patient who requires egg freezing, typically present?Yousif: Patients often fall into two broad categories. There are some women that come to do what we call elective egg freezing. Usually these are women in their late 20s or early 30s who want to preserve their fertility for non-medical reasons; like not having current partner, career planning, or not feeling ready for parenthood just yet. The other group, though, are what are classified as medical egg freezing. Medical egg freezing refers to egg freezing for women who are about to undergo treatment that could potentially harm their fertility. For example, chemotherapy for cancer, radiotherapy or certain surgeries. One example is surgery for severe endometriosis involving the ovary, especially in cases where endometriomas are present. Endometriomas are blood filled cysts caused by endometriosis, and they can damage the ovarian reserve overtime. What’s often underappreciated is that, when we surgically remove those cysts or endometriomas, it can also reduce egg reserve. That’s why it’s strongly recommended to have a discussion with a fertility specialist before undergoing such procedures; to consider fertility preservation options like egg freezing, and for some moment it might be embryo freezing. Occasionally we also see patients referred by their GPs after abnormal ovarian reserve test, like low AMH, or those who have a strong family history of when premature ovarian failure. And the other group that sometimes we see is for fertility preservation before gender affirming or surgical treatment.
Question 2
What are the risks or efficacy of the egg freezing?Yousif: Overall, egg freezing is considered as very, very safe. With the main risk being related to the ovarian stimulation itself, such as ovarian hyperstimulation, which is rare these days with modern protocols and what we call an agonist trigger. There is discomfort or bloating during the stimulation phase, which can last for a couple of weeks; it is probably the most common bloating and tiredness. And very low procedure risk during the actual egg collection itself, such as bleeding or damage to the uterus, bladder, bowel or any other organs because we follow the needle all the time by ultrasound. And in terms of efficacy, age at the time of egg freezing is the biggest predictor of success. Egg freezing before the age of 35 generally have higher success rates. And for women under 35, freezing roughly 20 mature eggs typically will give them a very good chance, around 90% chance of having 1 child in the future. The number needed may be higher for older women as egg quality and quantity naturally decline with age. That’s why it is so important to raise awareness and have those conversations early, so women have the knowledge, the time and options to make confident, informed decisions about their fertility; and that’s where GPs come in.
Question 3
What are the treatment options?Yousif: The primary treatment is the egg freezing cycle itself. There will be hormonal stimulations, usually in the form of injections for roughly about 10 to 12 days. We do monitoring by transvaginal ultrasound scans, occasionally trans abdominal scans and blood tests. And then egg retrieval via minor transvaginal procedure, usually done under sedation. And cryopreservation of the mature eggs using vitrification or snap fast freezing, which is usually done in the lab. If the woman later decides to use her eggs for IVF, usually with ICSI or intracytoplasmic sperm injection, which involves injecting a single sperm into each egg, we use this in a state of conventional IVF because after freezing, the egg shell itself can become a bit harder, so it might be harder to fertilise by conventional IFC, instead of using of ICSI. This can be used with either their partner’s sperm or with donor’s sperm in the future.
Question 4
Have there been any developments in treatment in the last years or are there any in trials or development now?Yousif: Yes, absolutely. There are probably a couple of points to make here. Vitrification or the fast freezing process, has significantly improved the survival rate of frozen eggs, compared to the old slow freeze technique. The old technique with slow freezing used to cause eye ice crystal formation inside the eggs which could damage them, as opposed to the new process, which is vitrification fast freezing, you almost freeze the egg and a glass like state, and they tend to survive much better. And the other thing to consider is AMH testing, which is a blood test, AMH stands for antimalarial hormone, it’s a blood test to estimate the ovarian reserve, kind of how many eggs we have in the basket. We combine that normally with an ultrasound scan to count the resting eggs or antral follicles on the ovaries; both will help us to personalise and tailor the simulation protocol, and also to predict the response. There’s also increasing research into artificial intelligence. Either an embryo selection or egg quality selection and improvements in ICSI techniques which indirectly benefit those using frozen eggs.
Question 5
Are there any warning signs that a GP or their patient could look out for?Yousif: Yes, of course. While egg freezing is elective for most women, warning signs where fertility preservation should be considered urgently include, a recent cancer diagnosis where chemotherapy may be used; and we know chemotherapy, for the most part, can be toxic to eggs. Or if they have autoimmune conditions requiring gonadotoxic treatment, this is treatment that is toxic to egg and sperm, some of these medications can act like toxins, almost in a similar way to chemotherapy, and it can accelerate the loss of these precious cells overtime. Or if a woman has a strong family history of early menopause, it’s really important to be proactive and discuss her options early in life. And there’s also symptoms that a woman might experience, that can indicate declining ovarian reserve. Such as a irregular cycles, or could be a blood test showing low AMH. As we know, early referral can make a significant difference in preserving future fertility.
Question 6
What is the likelihood of needing to use frozen eggs or repeating the procedure?Yousif: The reality is, not all patients will return to use their eggs. Many go on to conceive naturally without using to use those egg. However, some who freeze their eggs would return to use them, and some some may require more than one cycle to bank an adequate number of eggs to start with. I always say if you have those eggs frozen when you’re younger, when you come back to use them, you almost donating them to your future self. In terms of repeated cycles, it depends on their response. Women with low ovarian reserve may be advised to undergo multiple runs to achieve a reasonable chance of success, but it is always important to individualise the recommendation depending on the person’s circumstances and their needs. For example, the way we treat someone who as an ambition to have one child, versus someone who might have an ambition to have four children, would be quite different.
Question 7
When should a GP refer?Yousif: GPs should consider referral when a woman expresses interest in the future of her fertility, but is not ready to start a family, right now. Especially for ages approaching mid to late 30s, and I would encourage them to have those conversations, even with younger women. Or if there is a non medical condition that may impact ovarian reserve, or it is a patient newly diagnosed with cancer or autoimmune diseases where they might need gonadotoxic treatment. And it’s really important not to forget to ask about family history, especially of premature ovarian insufficiency, or premature menopause. Early referral can maximise their options and their chances of success, especially if it is done before the age of 35.
Question 8
What role does the GP play in the egg freezing journey?Yousif: GPs play a vital role; they’re really crucial. They can identify candidates really early based on their medical history or their concern that they could present with to the GP. They could order all the preliminary tests like AMH, FSH, LH and also an ultrasound scan to look at the entrance follicle count. And they’re really crucial for doing that early counselling about the timeline, about the success rates and also about realistic expectations. And let’s not forget they are always there to support those patients emotionally during the decision making process, particularly for those patients who might be faced with the new cancer diagnosis. And for our GP colleagues, you’re often the first port of call, and your guidance is key.
Question 9
Thank you for your time here today in the PodMD studio. To sum up for us, could you please identify the three key take home messages from today’s podcast on egg freezing.Yousif Absolutely, let’s take three main messages. Age matters the most: the earlier eggs are frozen, ideally before the age of 35, the better the outcome in the future. Egg freezing is safe and increasingly effective thanks to advancements in vitrification or fast freezing and the IVF techniques in the lab. And finally, GPS are vital. Early identification counselling and timely referral can make all the difference for patients exploring their fertility options.
Thanks again for your time and the insights you’ve provided.
Yousif: Thank you.
