Boutique Egg Freezing....an emerging trend in ART

Boutique egg freezing

1. BOUTIQUE EGG FREEZING

2. EGG FREEZING Human  oocyte cryopreservation  ( egg freezing ) is a procedure to preserve a woman's eggs ( oocytes ). This technique has been used to enable women to postpone pregnancy to a later date – whether for medical reasons such as cancer treatment or for social reasons such as employment or studying. Several studies have proven that most infertility problems are due to germ cell deterioration related to ageing. ]   The uterus remains completely functional in most elderly women, which implies that the factor which needs to be preserved is the woman's eggs. The eggs are extracted, frozen and stored.

3. The intention of the procedure is that the woman may choose to have the eggs thawed, fertilized, and transferred to the uterus as  embryos  to facilitate a pregnancy in the future. The procedure's success rate (the chances of a live birth using frozen eggs) varies depending on the age of the woman, and ranges from 14.8 percent (if the eggs were extracted when the woman was 40) to 31.5 percent (if the eggs were extracted when the woman was 25).

4. INDICATIONS Oocyte cryopreservation can increase the chance of a future pregnancy for three key groups of women: those diagnosed with  cancer  who have not yet begun  chemotherapy  or  radiotherapy ; those undergoing treatment with assisted reproductive technologies who do not consider embryo freezing an option; and those who would like to preserve their future ability to have children, either because they do not yet have a partner, or for other personal or medical reasons.

5. PROCEDURE: The egg retrieval process for oocyte cryopreservation is the same as that for  in vitro fertilization.   This includes one to several weeks of  hormone  injections that stimulate  ovaries  to ripen multiple eggs. When the eggs are mature,  final maturation induction  is performed, preferably by using a  GnRH agonist  rather than  human chorionic gonadotrophin  ( hCG ), since it decreases the risk of  ovarian hyperstimulation syndrome  with no evidence of a difference in  live birth rate  (in contrast to fresh cycles where usage of GnRH agonist has a lower live birth rate).  [2]  

6. The eggs are subsequently removed from the body by  transvaginal oocyte retrieval . The procedure is usually conducted under  sedation . The eggs are immediately frozen. The egg is the largest  cell  in the human body and contains a high amount of water. When the egg is frozen, the  ice crystals  that form can destroy the integrity of the cell. To prevent this, the egg must be dehydrated prior to freezing. This is done using  cryoprotectants  which replace most of the water within the cell and inhibit the formation of ice crystals. Eggs (oocytes) are frozen using either a controlled-rate, slow-cooling method or a newer flash-freezing process known as  vitrification

7. Vitrification is much faster but requires higher concentrations of cryoprotectants to be added. The result of vitrification is a solid glass-like cell, free of ice crystals. Indeed, freezing is a phase transition. Vitrification, as opposed to freezing, is a physical transition. Vitrification eliminates ice formation inside and outside of oocytes on cooling, during cryostorage and on warming. Vitrification is associated with higher survival rates and better development compared to slow-cooling when applied to oocytes in  metaphase II  (MII). 

8. Vitrification has also become the method of choice for  pronuclear  oocytes, although prospective  randomized controlled trials  are still lacking. [4] During the freezing process, the  zona pellucida , or shell of the egg can be modified preventing fertilization. Thus, currently, when eggs are thawed, a special  fertilization  procedure is performed by an  embryologist  whereby sperm is injected directly into the egg with a needle rather than allowing sperm to penetrate naturally by placing it around the egg in a dish. This injection technique is called  ICSI  (Intracytoplasmic Sperm Injection) and is also used in IVF. Immature oocytes have been grown until maturation  in vitro , but it is not yet clinically available.

9. Over 50,000 reproductive-age women are diagnosed with cancer each year in the United States. [1]   Chemotherapy and radiotherapy are toxic for oocytes, leaving few, if any, viable eggs. Egg freezing offers women with cancer the chance to preserve their eggs so that they can attempt to have children in the future. Oocyte cryopreservation is an option for individuals undergoing IVF who object, either for religious or ethical reasons, to the practice of freezing embryos. Additionally, women with a family history of early  menopause  have an interest in fertility preservation. With egg freezing, they will have a frozen store of eggs, in the likelihood that their eggs are depleted at an early age.

10. Boutique Egg Freezing: Empowering technology or Marketing Phenomenon? A Word of Caution Presented by Dr N S Sai Anusha PG-II Year OBG & GYN

11. Abstract The introduction of oocyte vitrification has propelled the field of oncofertility However, it is becoming increasingly common to offer planned oocyte cryopreservation to healthy, fertile women due to a lack of partner or other personal issues. Aim of the Article Pros and Cons of planned oocyte cryopreservation along with potential exploitation issues by unregulated clinics and international agencies

12. History In 2013, the American Society fo reproductive medicine (ASRM) removed the experimental label from oocyte cryopreservation (OC). Since then, this technology has become routinely offered as a fertility preservation option to women preparing to undergo gonadotropic therapy which may result in compromised or complete ovarian failure. With the advent of vitrificaiton technology and its reassuring outcomes, OC for fertility preservation increased from 6090 cycles in 2014 to 13,275 in 2018; a nearly 120% increase.

13. Present Scenario Today, women use OC not only to cryopreserve oocytes prior to cancer treatment but also for non medical indications- referred to as planned oocyte cryopreservation (POC) or social egg freezing. The use of POC to potentially safeguard against age-related fertility decline contradicts current ASRM – Society for assisted reproductive technology (SART) Guidelines that specifically caution about this practice. This opposition stems from limited data about Ocs safety, efficacy, indicaitons , long-term effects, cost-effectiveness and emotional risks for healthy women of reproductive age.

14. OC Services OC Services are increasingly being provided worldwide by infertility clinics but also by egg freezing start-up companies that frame OC as a “feminist pathway to independence” offering control over fertility. These companies target reproductive aged women concerned over their lack of a significant relationship and offer events marketed as “educational”, such as egg-freezing pop-ups, curbside vans and cocktail parties. OC services, too, package entertainment with treatment; one option, “ eggcations ”, provides discounted OC services combined with relaxing vacation

15. POC Services While growing in popularity, POC marketing raises concerns regarding inadequate disclosure of down-stream costs and issues, including egg thawing, ICSI, Embryo development, embryo transfer, re-freezing of embryos and inherently complicated disposition options. Furthermore many women may leave their country for cross-border reproductive care (CBRC) due to legal restrictions or for financial reasons. CBRC carries its own risk to women, such as possibility of receiving unclear information and consequences of making treatment decisions based on economic rather than medical reasons.

16. It is imperative for health care providers to fully explain to women considering POC the implications and limitations of using ovarian reserve tests. A convenient assessment of ovarian age, anti – mullerian hormone (AMH) may induce unsubstantiated anxiety regarding fertility in women not of age. Additionally the fact that many women (those especially under 34 years of age) have a high likelihood of never using cryopreserved eggs means that women may overvalue POC. Furthermore, there is lack of consensus regarding the optimal timing of POC.

17. Other issues frequently not addressed include the low but possible risk that no oocytes will survive thaw, failed fertilization or lack of embryo implantation; an increased maternal morbidity in older pregnant women; and still unknown long-term child outcomes. POC while not endorsed by ASRM & ACOG, is expanding and a popular option for women seeking to delay child bearing.

18. CONCLUSION Our understanding of short and long term implications of OC is still in its infancy. Thus, as health care providers, we must provide women with realistic expectations, full informed consent and non judgemental support as they negotiate multiple pressures and decisions regarding family building to ensure they are not cajoled into freezing their eggs. Our professional responsibility is to encourage, not undermine reproductive autonomy and reproductive liberty.

19. Reference The journal of obstetrics and gynecology of india (September – October 2021), Volume 71 by Dr. Shruti Agarwal

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