In our previous interview with Dr Helena Lim, we got to know about the book “Catching My Baby Dust” that documents stories of 14 couples who underwent the IVF journey. We continue our talk with Dr Helena and today we will hear from her about Egg Freezing.
Egg Freezing is a process in which a woman’s eggs (oocytes) are extracted, frozen and stored. Later, when she is ready to become pregnant, the eggs can be thawed, fertilized, and transferred to the uterus as embryos. Is egg freezing an option for you? Find our more from Dr Helena Lim.
GetDoc: Hi Dr Helena, Egg freezing technique, what is the trend in Malaysia? Did you see a rise after Apple and Facebook announced last year they’d cover egg-freezing in their employee health plans?
Dr. Helena: Egg freezing has gained popularity in Malaysia over the years; however I do not see the correlation between the increased numbers and the announcement by Apple and Facebook.
However, whenever someone is diagnosed with cancer, the first thing that strikes people’s mind is ‘is my child going to die?’ or ‘am I going to die?’ They are carried away with getting off the cancer, paying attention as preserving fertility seems to be ‘wasting time’. However, patients should not rule out this option, should they want to have offspring in future.
GetDoc: Is Egg Freezing just hype?
Dr. Helena: To be frank, egg freezing is not for everyone. Doctors won’t recommend it as a treatment option unless there is no other choice. For example, some women have to go through certain treatments such as chemotherapy or radiotherapy wherein the treatments will affect their infertility, destroy their healthy follicle, and healthy eggs. In these scenarios, if they do not have a partner or have been diagnosed with cancer at early years of their life, say 18 or early twenties, egg freezing is a very good option.
With technological advancement, we are seeing more cancer survivors. Women survive cancer, leukemia or even bone marrow cancer. With egg freezing technique, they are able to enjoy the quality of life they desire. They can have children in their later stage of life.
GetDoc: How has the technology advanced, and how did it contribute to the success rate of pregnancy?
Dr. Helena: We are speaking so much about egg freezing today but this wouldn’t have been the case, say about 10 years ago – this is because science has improved. 10 years ago, if we look at the traditional way of freezing embryos, if you applied that to egg freezing, the outcome would have always been virtually a failure. To give you an example, the world’s first frozen embryo baby was born in year 1984. The first baby born from egg freezing was in year 1986.
A little science fact about the egg: the egg is the largest cell in the human body. It contains all the information that makes us what we are. We come from the egg, the sperm’s only function is to bring the chromosome in there. But the chromosomes in the egg are very unstable. The process of freezing and thawing puts enormous strain on the chromosome. Sometimes if you thaw them, they just don’t come out right, in fact, most of the time, they didn’t. The old way of freezing is to take an egg from room temperature down to -196 degrees over a period of about 2 hours, removing fluid from the egg very slowly then replacing it with something that prevented ice crystal from forming.
The new way of freezing, which is called vitrification, takes the egg from room temperature to -196 degrees Celcius in less than a millisecond. The rate of temperature loss is 10000 degrees per second. It’s that fast. So it’s called flash freezing, it doesn’t even have time to realize that it’s been frozen. And the thaw is equally fast. So it freezes as it is standing. It thaws immediately, so it remains stable, that’s what is revolutionary, not just egg freezing, and also embryo freezing, embryo freezing is astronomical. Embryo freezing is done the same way.
GetDoc: Is egg freezing prohibited in Malaysia?
Dr. Helena: Muslim women are forbidden to freeze their egg before marriage. However, it is not prohibited to other women of other religions. Having that said, there are still some Christians who have concerns over this process when it comes to the question of discarding the unused eggs and embryos.
GetDoc: What happens during egg freezing process?
Dr. Helena: It actually involves putting women through a treatment cycle, which is actually very similar with IVF. It involves giving them injection to upto 10 – 12 days to stimulate all the eggs to grow. I mean for all the follicles to grow to a certain size, then we take the women to the operation theatre, put the needle through the vagina, harvest the egg, then go through the lab, freeze all the egg. This process is very similar to IVF, just that we take away the fertilization of the egg part, we do not replace the embryo back to the uterus.
GetDoc: How long do you keep your eggs for?
Dr. Helena: There seems to be no end point. Country has laws as to how long you can keep embryos. So if you haven’t come back to ask for your embryos back up to 10 years, by law in most countries, the clinics are able to dispose them. Because fertility centres don’t know how long they can keep them for. When a woman freezes her egg, there is a possibility that she freezes at the age of 17 or 18 and comes back for the egg at age of 41.
Once an egg is frozen and frozen properly, it’s stored in liquid nitrogen, which provides the coldest known temperature on earth: -196°C. At that temperature, all biological activity is effectively stopped. The cells are not metabolizing or depleting their energy reserves. Bacteria or other microbes cannot attack or degrade the egg cell in any way because they are also unable to function at such a low temperature. Everything is on hold. Once you have frozen it, as far as we know, it’s probably forever.
GetDoc: Egg freezing is expensive, is there any other alternative should one want to consider egg freezing?
Dr. Helena: Given the delicate technique, and storage being used in this process, there is no other alternative.
GetDoc: How important is consultation?
Dr. Helena: It is very important that patients are aware of what they are getting themselves into. We have to ask the patients, what was the reason you chose egg freezing over embryo freezing. A lot of times these women would tell us ‘Look, I’m 38 or 39 years old, hitting the big 40. I don’t have a partner at the moment, and I’m not sure whether in 2 years down the line, whether I’m going to have a new partner. I am fully aware my chance of pregnancy goes down after 40 years old. Is it a good idea to have my eggs harvested now, have I hit the age of 40, to use my eggs later on.’ I think it is actually a very good and relevant question. Egg freezing doesn’t insure fertility, however it is an option, and the patient has to be fully aware that sometimes it may not work. 5 years down the line, after the egg is harvested, sometimes you find that when you thaw, they are not able to be fertilized.
GetDoc: Do you screen for infectious disease before egg freezing?
Dr. Helena: Yes we do.
GetDoc: What sort of infectious diseases?
Dr. Helena: Hepatitis B, HIV, and so on.
GetDoc: In the UK, most clinics will turn you away after you are 38 years old, they will tell you that without young eggs, it’s not worth the time or money, would you agree?
Dr. Helena: I wouldn’t turn the patients away. I’m very pro people who have difficulties in their fertility. I will put the numbers to them, telling the patients now that they are 38; the chances are lower as compared to when they were 35 years old. But I also tell them that they are better than when they are 40 years old. As long as they understand the perspective as to where they stand, it is fine. If patient came at 44 years old, the chance of pregnancy dropped to less than 10%. At 35 to 40 years of age, our statistics showed that each time you put each embryo back; your pregnancy rate is about 40 to 50%. So why don’t you freeze your egg at 38, 39 years old, you still have the 30 to 40% chance of having a child, each embryo transfer.
GetDoc: How to ensure successful pregnancy with egg freezing, especially in women who have crossed the age of 40?
Dr. Helena: Successful pregnancy not just depends on egg fertility, but also overall fertility as a person. Egg fertility is at its peak when you are in your 20s or early 30s. If you can freeze that for 10 years, and you take it out 10 years later, your fertility is still where it was when you froze it 10 years ago. In the meantime, if you have gone from being a slim, healthy one to diabetic, high blood pressure, it will definitely jeopardize your fertility chances. Generally women who are 45 years are healthy, they are still able to carry a child, of course, and the risks for them are higher.
That was another enlightening interview! We hope you have learned quite a bit about Egg Freezing and who can do it and how.