Dr Anadeep Chandi

Social freezing is a term used when a person is not ready for motherhood in near future and want to preserve her fertility by freezing her eggs.

Women have short window of maximum fertility which tends to decline with age. It has been seen that a women can only produce around 400 eggs in her entire life. In some women, the number of eggs tends to decline at a faster pace.

Environmental factors like adulterated food, polluted air, polluted water, increased exposure to electromagnetic radiations, etc. have lead to certain detrimental effects on human gametes and fertility thereby.

Shifting of marriageable age due to unemployment, social insecurities, career concerns, etc has added the burden on declining fertility.

Fertility preservation in such cases can save the women from fertility issues related to age. Also, advances in medical sciences leading to early detection of cancer has given added advantage to the patients to undergo such procedure to restore the dream of becoming a parent in the later life.

Oocyte Freezing procedure involves few steps to follow. 

Step 1: Basic work up involving blood tests like TSH, Prolactin, FSH, LH, Blood sugars, AMH, anaesthesia check up (PAC) and a pelvic ultrasound (USG). Pelvic ultrasound can be done trans-vaginally (not accurate) or trans-abdominally (in virgin girls). 

Step 2: Ovarian stimulation: this process starts on day 2 of periods. Few hormonal tests like Serum FSH, LH, Estradiol, etc. are sent and day 2 USG is done to see the total antral follicles in both ovaries. Antral follicles are follicle of size between 2-8 mm size. Synchronicity of these follicles is checked. Sometimes, one or two of these follicles may be ahead of growth as compared from the other cohort. In such cases, the stimulation may need to be canceled as asynchronous cohort lead to less number of oocyte retrieved leading to unexpected poor stimulation outcome.

Once, the blood test reports come within normal range, and the USG report is favourable, the ovarian stimulation is started with hormonal injections. These injections can be administered subcutaneously or intramuscularly in the morning hours. The administration of these injections should be under strict medical guidance as improper administration may lead to improper dosage leading to slow or less response of follicles.

The Ovarian stimulation is monitored closely with the help of hormone tests and ultrasounds. The ovarian stimulation usually takes 9-11 days to complete. Once the follicles reach maturity level i.e. the lead follicle reaches the size of 18 mm or more, a trigger injection usually HCG injection or GnRH agonist injection is given to trigger the maturity of the eggs. 

Step 3: Egg Retrieval procedure: It is planned around 35-37 hours after trigger injection. This procedure is done under anaesthesia, usually short general anaesthesia or I/V sedation. Sometimes, the doctor may consider spinal anaesthesia in difficult cases where approach to ovaries is through the uterus (trans-myometrially) or abdominally (trans-abdominally).

The patient is asked to come in fasting state of 8 hours. The procedure last for usually 30 min. A thin long needle is passed through vagina into the ovaries and ovarian follicles, and follicular fluid is aspirated out and sent to special IVF Laboratory to check for the presence of mature eggs (MII).

The mature eggs are freezed and stored in the cryo-canisters for later use. The egg freezing can be done easily for 5 years and in some cases upto 10 years also. 

Is Oocyte freezing Painful?

Yes, oocyte freezing can be painful for few ladies. Daily administration of hormonal injections can cause injection site pain. Some ladies may not be able to bear the pain related to trans-vaginal ultrasound. Such ladies may opt for trans-abdominal ultrasound. Also, the growing ovaries may lead to stretching effect in the lower abdomen. Egg retrieval procedure is painless as it is done under anaesthesia. Post procedure, few ladies may experience slight pain that is confined to lower abdomen and thighs. 

Is there any side-effect of oocyte freezing procedure?

No. Oocyte freezing doesn’t involve any side-effect. The hormonal injection may lead to slight weight gain, and sedation. The effects are short term, as these hormonal drugs wash out from the body very fast. A rare incidence of ovarian hyperstimulation may occur which may need prolonged medical attention. Rarely, intra-operative bleeding may occur which may need prolonged observation and hospitalisation.

Does Oocyte freezing procedure need bed rest?

No. The lady may continue her daily routine activities easily. The lady may be advised to restrict heavy physical activities, lifting heavy weights, prolonged bending etc, so as to prevent twisting of the bulky ovaries around its pedicle.  

Who all should undergo Oocyte Freezing?

• Advancing age
• Diagnosed with Endometriosis
• Diagnosed with Pelvic cancer
• Delaying marriage due to any reason

What is Semen Freezing? 

Semen freezing is done in male cancer patients who are diagnosed with testicular carcinoma or who need pelvic radiation or gonado-toxic chemotherapy or men who are undergoing declining semen quality. Such men may undergo semen freezing. It is painless, single sitting procedure. The man is asked to produce semen sample through masturbation in a wide mouth container. The sperm survival rate after thawing is around 75-80%, therefore it is recommended to get two semen straws freezed. 

What is Ovarian Cryopreservation?

Ovarian Cryopreservation involves freezing of ovarian cortical tissues in the form of thin slices for prolonged period of time. It is done in young girls who need to undergo chemotherapy or pelvic radiotherapy of cancer treatment. It involves high expertise. These thin slices of ovaries are then transposed back into the body in the later life once the cancer is cured.

What is the cost of Oocyte freezing?

The cost of oocyte freezing can be divided into two parts. One part deals with hormonal injections that vary from person to person. The number of ovarian stimulation days, type of the hormonal injections used, and the dose of the hormonal injection depends upon the body mass index, serum AMH, antral follcile count (AFC) and age of the lady. Sometimes, the ovarian stimulation may go upto 12-13 days. And, sometimes, the stimulation may end in 8 days also. Therefore, the cost of hormonal injection may vary from INR 35K to 70K.

The second part of the cost involves IVF laboratory. Usually, it ranges from INR 30K to 75K, and varies between IVF centres depending upon their services.

What is the success rate of Oocyte freezing?

Nowadays, with the advancement of the medical technology, the oocyte survival rate after vitrification has improved a lot. It has been seen, the oocyte survival ranges from 90-95% and pregnancy rates are matching well with the embryo freezing cases.