To Freeze or Not to Freeze? That is the question!
I decided to share my experience of egg freezing in Melbourne as I really struggled to find reliable information about it, particularly in relation to the processes in Australia. I am a health professional with training in critical appraisal of research evidence and found that I had to wade through a lot of information and clever marketing by IVF companies to find reliable information.
Despite the road to equality women have fought for over the decades, there is unfortunately still very little we can do to stop the biological clock. From my GP telling me I should have kids soon at age 24, relatives nagging, attending friends' endless baby showers, making the decision to complete postgraduate study, my sister having a failed round of IVF, breaking up with a long term boyfriend ... thoughts begin to creep in about how much time I had before the decision was no longer mine.
Why did I consider egg freezing?
I started to seriously consider egg freezing in my early thirties. My new partner had always been unsure about kids and after 3 years, I was aged 33 and thought it was time to investigate further. COVID had also halted my plans to travel overseas, meaning my general life plans were potentially being pushed out a year or two. I have heard similar from many others who have been affected similarly by COVID. A friend was also going through the process at the same time as I was. We both found that reliable information was scarce and had no idea what to expect.
The decision to freeze your eggs is very individual, and every person will have different circumstances that impact upon their decision making. It is ultimately important to be as aware of the facts as possible before making that decision for yourself. It is also important to note that I am not a fertility specialist and it is important to speak to a professional (and even consider a second opinion from another specialist) before making an informed decision.
The research
I will preface this by saying that the research is rapidly evolving so again, I would encourage you to ask the hard questions, and look to the best available evidence based practice as part of making an informed decision around egg freezing. I am a health professional with training around critical appraisal of research evidence and I found it difficult to navigate the research out there currently.
Research around egg freezing is lacking because it has only recently become more popular in the last 20 or so years. Some research exists around 'social egg freezing', but there is more research about IVF. IVF is in many ways similar, however, the issue with this is that many people previously undergoing IVF had fertility problems, thus skewing the research evidence. IVF protocols vary widely (as does egg freezing), and some IVF research is around 'fresh transfers' which are not utilised with egg freezing (as that would defeat the purpose of egg freezing).
Ideal age for egg freezing is usually quoted as early thirties. This is because eggs are generally not stored longer than 10 years, and egg reserve and quality decreases with age. For this reason, egg freezing is not usually recommended > 40 years.
More recent research into 'social egg freezing' has led to development of an algorithm to predict likelihood of having a baby after egg freezing. I found this article the Victorian Assisted reproductive Treatment Authority (VARTA) really helpful: https://www.varta.org.au/resources/news-and-blogs/whats-your-chance-having-baby-frozen-eggs
To paraphrase, success of egg freezing depends upon:
1. Your age when you freeze your eggs.
2. The number of eggs stored.
3. How many cycles you can afford.
This table shows how age affects how many eggs are needed for 80% chance of a baby, based upon research by Goldman et al. (2017).
|
The woman’s age at the time of egg freezing |
Number of eggs needed for 80% chance of baby |
|
35 years or less |
14 |
|
36 |
17 |
|
37 |
24 |
|
38 |
27 |
|
39 |
33 |
|
40 |
45 |
Data from 2019 in Victoria also suggests that most women will need to undergo at least 2 x egg retrievals to have enough eggs for 80% chance of a baby.
|
Age at egg retrieval |
Average number of eggs |
|
Less than 35 |
13 |
|
35-39 |
10 |
|
40 or more |
7 |
(VARTA, 2021)
Here
is a similar graph from 2017:
Of the eggs that are frozen, some will not survive thawing, some will not develop into embryos and not all embryos will successfully implant. There is limited research around what happens after social egg freezing, but it suggests that
- Most women who froze their eggs 'socially' due to lack of an appropriate partner rather than career or lifestyle reasons
- most pregnancies after egg freezing were from natural conception
- very few women had used their eggs (but potentially more of these women as they got older would use them in future) (Pritchard et al., 2017; Hammarberg et al. 2017).
Take home messages
- Egg quality decreases with age
- Egg freezing is not an insurance policy
- 1 egg does not = 1 baby
- Success rates depend on age at time of freezing, number of eggs collected and ability to afford expensive IVF cycles
- Currently, many women who freeze their eggs never use them
Costs
Egg freezing in Australia can cost between $5000-$13,000 per round of egg retrieval, dependent upon your medical history and chosen clinic. Some costs related to egg freezing may be covered for certain medical conditions.
Costs usually include the egg freezing cycle, plus medications, anaesthetic or other fees related to the procedure, and egg storage fees. Medicare in Australia does not cover egg storage for medical or social reasons. This can cost from $50-500 per year.
The later IVF cycles required can then cost from $9000-$15,000, with out of pocket expenses of up to $4,600. (Canstar, 2019). Some top level private health insurers will cover fertility treatment, and again if you have a medical condition some costs may be covered by medicare in Australia.
Why did I personally decide to freeze my eggs?
I weighed up the pros and cons and ultimately for me, I pictured my future self kicking my past self for not doing it whilst I could to keep my options more open.
Pros
- Potentially better options later if I do want to try for a baby in a few years
- I was still at a reasonable age to freeze eggs
- Financially I was lucky enough to currently be able to afford to do egg freezing and predicted I would likely be able to afford rounds of implantation later
Cons
- No guarantees of a baby later
- Inconvenient, uncomfortable
- Cost of procedure, storing eggs, and future IVF rounds
- May never use frozen eggs if conceive naturally
- Potential complications to procedure (eg. OHHS- ovarian hyperstimulation syndrome, infection)
- Time off work
- Potentially may not be able to afford IVF later
How to choose a fertility service?
Fertility services will differ significantly in cost, protocols, and services provided.
I initially spoke to some friends who had done IVF about their experiences. I looked at reviews online, and joined a couple of IVF groups to search through and see which doctors or clinics were recommended. Egg freezing and IVF are obviously very personal experiences and I cannot even imagine how disheartening failed rounds would be. Dissatisfaction with some doctors was certainly very obvious in many of the reviews/ suggestions online. That said, some of the reviews were in regards to doctors not being very personable or being pessimistic about their chances of conception. I personally have worked with many amazing doctors who are not very personable so from my perspective, I was wanting a doctor and clinic with good skills who would tell it to me straight, rather than potentially drag out the process with false hope or do a bad job. This will not be everyone's preference.
After doing some scoping online, I did the free initial consultation at two clinics I narrowed it down to one which was a stand out and had lots of glowing reviews - No. 1 Fertility. For the record- this post is not sponsored in any way.
I decided not to go with Monash IVF as a I found the nurse pretty vague during the consultations. No. 1 Fertility is Lyn Burmeister's clinic, and if you haven't heard of her yet in Australia on your fertility journey - you soon will. I was a big fan and would definitely recommend her and the clinic to others. This article about her is particularly fascinating for some background.
Distance from home is definitely another factor to consider as you will need to be able to attend appointments regularly and at the drop of a hat during the egg freezing cycle .
Initial information appointment
The initial appointment was via telehealth (due to COVID) which was an information session with a nurse. She talked through the process and answered any questions I had. I was emailed a written information pack with good detail. Next steps were to do the baseline fertility tests and go on to the second appointment with the doctor.
I needed to come off contraception for at least 3 months to get more accurate blood results so I did this. I had been on the oral contraceptive pill for over 10 years and was dreading this a bit. My skin broke out a bit otherwise it was very manageable. It also highlighted than my previously regular and heavy periods were now grossly irregular and not very heavy. I used ‘clue’ the app to track my cycle and symptoms etc which was very handy. From never having done this before, it makes the patterns clearer (if there are any!).
I went for an outpatient ultrasound (US) which was transvaginal (not a big deal), and blood tests. Melbourne pathology missed half the tests required so I had to go back and do the ones they had missed again (annoying).
Second appointment with a doctor
I had the second appointment again via telehealth with the doctor to review my results and talk through the potential treatment plan. She ran through my results and said my fertility was just above average for my age. The doctor who does this appointment is not necessarily the one who will be doing your egg retrieval.
At the time, the doctor told me my US result was normal. Later a nurse told me I had borderline polycystic ovaries (additional follicles). Following this during the egg freezing cycle I was told I had polcystic ovarian syndrome (PCOS) and was at higher risk for Ovarian hyper stimulation syndrome (OHSS)- a complication of egg freezing. I would have liked to know prior to making a decision about proceeding. That said, I think I would have gone ahead regardless. Do note, polcystic ovaries and PCOS are not the same thing.
Telehealth was quite convenient for both these appointments and definitely made the process easier for me around work etc.
Planning for the egg freezing cycle
I was keen to get the cycle over and done with ASAP. The doctors recommend you take supplements and live a healthy lifestyle for at least 3 months prior to your egg collection eg. Mediterranean diet, less than 5 alcoholic drinks per week, exercise regularly etc.
I took the vitamins for 3 months - these were quite expensive (approx $150) on a relative scale. I already have a fairly healthy lifestyle but cut down on alcohol (probably still had more than 5 drinks on the weekend though).
I’d recommend picking up the drugs a few weeks before so you’re ready. In my case the pharmacy has you book an appointment to run through everything which is helpful but again the spots were very booked so it’s better to be prepared and do this earlier.
The egg freezing process
On day 1 of your cycle, it’s time to call the fertility clinic who set up an online portal showing which drugs to take and when. I had to do bloods on day ? Which showed I was on track.
As it was my first cycle, repeat bloods and an early US showed I was progressing pretty quickly (and likely at high risk of OHSS) due to multiple follicles. This meant careful monitoring of bloods and cutting back the injection dosage as advised by the clinic. I was keen to avoid OHHS as it can lead to the cycle being cancelled, and make you feel very ++ unwell.
The injections themselves were a bit confronting - but definitely manageable. I work in healthcare and am not squeamish but there’s something about stabbing a longish needle into your own abdomen that isn’t quite right! That said- one of the injections had a cover like an epi pen and was not scary, however the mechanisms kept getting stuck and not injecting properly.
The nurses at the clinic tended to call back at the end of the day (often post the clinic oficially closing) to tell you the updated instructions post bloods. In one case, they said take half the dose of injection, however the dial did not go that low on the injection. I chose to load to the full dose and stop at half the vial - not ideal but the only option when the clinic and pharmacy were closed on the weekend. That said, the clinic although busy +++ were always good with getting back to my emails and calls.
Injections are timed fairly strictly too see consider this if you’re planning to be out and about. I maintained most of my usual routine- work, walks, gym but avoided jogging I think because I felt a bit yuck. I felt extremely bloated and put on about 7kgs (presumably fluid) during the cycle. Be prepared to feel gross, but it will pass.
Eventually I saw Queen Lyn herself and was given the go ahead for egg collection on the Saturday. I was prescribed the nasal spray trigger instead of an injection one as it lowers the risk of OHHS.
I went into the Epworth Freemasons in the morning, was out in the early afternoon. The twilight anaesthetic was fine - I remember going to sleep then instantly waking up in recovery. I had some moderate lower abdo pain post - which they promptly gave me some pain relief for. The nurses advises this was normal given the large number of eggs they collected.
I was incredibly lucky and 52 eggs were collected, of which 36 were mature enough to be frozen. Apparently 52 was a record! This is pretty unusual for one cycle and has a lot to do with PCOS. Apparently with PCOS, egg quality is generally lower so there are still no guarantees of a baby later on despite the larger number of eggs.
I was really only planning to give one cycle a go, but the aim was for around 14 eggs for my age <35 based on the table previously mentioned. Every cycle obviously increases your later chances so those with a lot of cash and patience would likely consider going again.
The aftermath
I had a festival on that day and felt ok so went to that and had a very low key day sitting down and listening to music. I’d probably recommend actually following advice and staying home for a quiet one. Have some pads ready and simple pain relief, plus no sex for a week.
I had a surprise heavy period a few days later, which no one had warned me about, but was confirmed as a normal side effect post nasal trigger. I felt much less bloated after that. Keeping moving helps to reduce risk of OHHS too, so I kept up gentle walking the week after.
Would I do it again?
I was extremely lucky to retrieve as many eggs as I did in one cycle so I’m really glad I did the egg freezing. I feel confident in the clinic I chose, and would recommend them to others for sure.
Again, I am realistic about the process and the likelihood that I may never use these eggs, or that IVF may not be successful if I do. At the end of the day, it’s a gamble I am privileged enough to be able to afford, and my experience was very uneventful compared others.
Sitting in the waiting room with many other women on their fertility journey and seeing their weary faces, it did make me realise what an incredibly difficult experience so many must face. Speaking to a few others about my plans, people opened up about their experiences or others they knew seeing the same specialist or trying another IVF round. It’s a reminder to be kind, as you never know what someone is going through. I cannot imagine the physical and emotional toll of multiple rounds of IVF and prey I never have to.
Good luck for all those considering, and fingers crossed as technology improves we can buy a little more time for ourselves!
References
Hammarberg, K., Kirkman, M., Pritchard, N., Hickey, M., Peate, M., ... & Fisher, J. (2017). Reproductive experiences of women who cryopreserved oocytes for non-medical reasons. Human Reproduction, 2017. 32(3): p. 575-581. doi: 10.1093/humrep/dew342
Pritchard, N., et al., Characteristics and circumstances of women in Australia who cryopreserved their oocytes for non-medical indications. Journal of Reproductive and Infant Psychology, 2017. 35(2): p. 108-118.
VARTA. (2021). What’s your chance of having a baby from frozen eggs? Retrieved from https://www.varta.org.au/resources/news-and-blogs/whats-your-chance-having-baby-frozen-eggs
VARTA (2017). What happens after egg freezing for social reasons? Retrieved from https://www.varta.org.au/resources/news-and-blogs/what-happens-after-egg-freezing-social-reasons
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