The pandemic, as we all know, has changed the world in more ways than one. And yes, fertility experts the world over have confirmed this-- a spike in egg-freezing procedures is yet another fallout of covid-19.
Egg freezing, a process in which a woman's eggs (oocytes) are extracted, frozen, and stored to preserve reproductive potential in a woman, may sound like a fertility freezer in a post-apocalyptic world. Companies like Apple and Facebook are now paying their employees for it and providing benefits to women who freeze their eggs. Of course, this does raise a number of complicated questions. Are these companies soft-selling the idea of delayed fertility with a big fat promise of hope in the future? Are women being steered to work round the clock without the need for a maternity break? Are these tech giants manipulating their employees' fertility without them realizing it, or are they just facilitating a woman's right to decision making? There are no easy responses to these questions; they are so dependent on individual choices and belief systems.
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Now, if egg freezing is something you are thinking about, it helps to have some facts in place. What exactly is egg freezing? Why are so many women turning to it? What are the benefits and cons of the procedure? I will try to offer you some answers.
Why freeze eggs?
Technically known as oocyte cryopreservation, it involves taking the woman's eggs, adding them to a preserving medium and freezing it at sub-zero temperatures. The first successful childbirth from frozen eggs was achieved in the year 1986. The most important determinant for egg freezing to result in a successful pregnancy is the age of the donor. Studies point towards the age of less than 35. But being above the age of 35 is not a criterion for not freezing.
There are two reasons why egg freezing is done
Elective freezing for social reasons: The social reason could be because she hasn't found a partner yet to have a child with or isn't ready for whatever reason- commonly: career-related delay to start a family.
Medical reasons for egg freezing: Many women need to opt for egg freezing for medical reasons. If a woman needs to undergo chemotherapy for cancer, she is advised to freeze her eggs so that they don't get affected by the toxicity of the chemo meds.
How does it work?
Egg freezing is as complicated as it comes. It requires a series of hormonal injections, namely FSH and HMG. Normally during each menstrual cycle, one egg matures and patiently waits for a sperm to fertilize it. But under the effect of these hormones, a woman's ovary is like one gumball vending machine, and multiple eggs will mature at the same time. So, if the patient's cycle is of 28 days and her periods are expected on the 1st of the month, her ovulation date will fall close to mid-month. (It's simple math, your ovulation date is two weeks before your next expected period date). That is the ideal time for the doctor to schedule the woman's visit. Her ovaries will be monitored serially by ultrasound, and when the eggs are ready, the retrieval is planned.
The operation consists of accessing the eggs through the vagina. Before you go 'gaaah!!', let me reassure you it's not a painful procedure and not even uncomfortable. The doctor will put you under general anaesthesia for a very short period of time (15-20 minutes). Next, an ultrasound is inserted into the vagina to locate the eggs in the ovary. This probe functions as both the locator of the eggs as well as the harvester. The probe has a needle at its tip and is inserted through the vagina to fetch the eggs. The woman, despite this scary-sounding procedure, wakes from anaesthesia just fine and is discharged the same day. About a dozen eggs are harvested and stored in each cycle.
Some women may opt for multiple cycles of hormone injections to store more eggs and increase their chances of conceiving. Dr Nirmal Bhasin, embryologist of Jannee fertility centre, Chandigarh, told me that if the woman wishes to harvest and store more eggs, a three-month gap is maintained between the two retrieval episodes. Dr Nirmal also told me that she prefers embryo freezing over egg freezing for better chances of conceiving.
Challenges and benefits
The Sophie's choice then for the patient here is whether shall she go for an anonymous sperm donor and freeze embryos (embryo is the product of when egg meets sperm) or should she freeze her eggs as is. Since the patient in question has a social reason for egg freezing, she is fraught with decision-making. Shall she opt for donor sperm and fertilize all her eggs' while they are still fresh'? Or shall she let her eggs approach an expiration date and conceive when she finds “the one”? The woman is counselled in-depth about that but again, a hard decision. Let us not forget about the cost involved too--egg or embryo freezing can be prohibitively expensive. With all the injections, ultrasounds and visits, the cost can easily cross two lakhs.
Another fact to consider is this--while it is fabulous that a woman holds the reins of her fertility, the challenges of parenthood may deepen with time. Even though her eggs are frozen in time and form, the rest of her body which is undergoing the process of ageing each passing day, may not be on her side. Her stamina to chase a toddler may be significantly reduced, for instance. Or she may become an empty-nester only after retirement.
With all these factors, social reasons and medical reasons in play, the decision is ultimately the woman's--having eggs in the freezer that can be thawed whenever she chooses to have a child does help her make some life decisions more easily.
Dr Farah Adam Mukadam is a Bengaluru-based family physician and author of Newborns and New Moms. She vlogs on Instagram and YouTube as Dr Farah_Momstein