Women today have the option of postponing their desire to have children through social freezing – the freezing of eggs. Tikbow spoke with an expert in reproductive medicine about what to know about the procedure, the costs involved and possible risks.
Whether for private or professional reasons, there are more and more women who want to postpone getting pregnant until later. Others are not yet sure whether they want to have children at all, but want to keep the option open for later and therefore preserve their fertility. This possibility is offered by so-called social freezing. The term stands for the freezing of eggs for sociological reasons, i.e. without medical cause. The right people to contact for this are reproductive physicians, i.e. doctors who specialize in reproduction (including under difficult conditions).
Freezing eggs – the best time
The decision to undergo social freezing should not be put off for too long, if possible. The reason for this is the quality and quantity of available eggs in the female body. To understand: girls are born with a fixed number of eggs (total quantity at this time: about 400,000), which is reduced by several dozen with each menstrual period from the time of puberty onwards. In addition, with increasing age, fewer and fewer of the remaining eggs are capable of development. According to experts, women between their mid/late 20s and 34 are at the ideal age. Above 35, the procedure is rather discouraged.
Procedure and duration of treatment
The eggs are retrieved from the ovaries through the vaginal opening. For this to be successful, they must have matured by means of hormone treatment (stimulation) and have reached a certain size. The patient has an explanatory and introductory consultation with the attending physician and then carries out the hormone treatment herself: by abdominal injection under the skin with special hormone preparations from the pharmacy.
Over an average period of two weeks, two injections are required daily, one in the morning and one in the evening. Doctors recommend avoiding strenuous physical exertion (sports, sauna sessions) and sex from around the middle of the stimulation phase; smoking is also particularly harmful under the influence of hormones. The injections do not hurt, but cause the eggs to grow, which can be unpleasant after a certain point. In addition, hormone treatment can cause mood swings.
In the meantime, the status of egg maturation is checked again and again in the doctor’s office or clinic. If the eggs are not yet large enough, the hormone therapy is prolonged accordingly. As soon as the desired degree of maturation is foreseeable, a date for the procedure is set and thus also the time for the last injection. 36 hours before the ovarian puncture, another hormone must be injected to prevent ovulation.
Procedure is painless
The procedure, which takes about 15 minutes – the so-called "puncture" – is performed on an outpatient basis and the patient is put into a deep sleep for it. The attending physician removes the oocytes from the matured follicles with a thin needle. After about three quarters of an hour, the sedation wears off and the patient can be picked up by an escort.
A few hours and days after the procedure, the patient may experience pain, which should not exceed the level of menstrual cramps. The patient can return to work the next day or the day after the procedure, as long as she feels comfortable and the work is not physically demanding. She should take it easy for a week.
Oocytes can survive storage at minus 196 degrees for years.
Immediately after the puncture, the oocytes are deep-frozen by vitrification and stored at minus 196 degrees Celsius. There they can be stored for many, many years (at least in Germany, in Great Britain the upper limit is ten years).
Pregnancy chances after social freezing
The patient decides if and when she wants to try to become pregnant, theoretically this is still possible beyond menopause. However, doctors usually advise against this. The pregnancy rate per attempt of artificial insemination with previously frozen eggs is about 25 to 30 percent. However, it must be borne in mind that such figures are very dependent on the results and that the male factor is also important.
Egg freezing – costs can vary greatly
The costs of social freezing consist of medical treatment and care, the number of necessary ultrasound examinations, egg storage (approx. 300 euros per year), the procedure and the price of the hormones. The latter accounts for a larger share. For a single procedure, the patient must expect to pay between 3,000 and 3,500 euros (including medication), which increases accordingly for subsequent attempts. The reason for this is that artificial insemination is usually carried out with 15 eggs per attempt. If the first stimulation does not produce the desired number of eggs, the conditions for pregnancy can be improved by repeating the procedure in a later cycle.
Note: The costs for egg freezing are usually not covered by health insurance. Only if a certain disease such as cancer or rheumatic diseases are present, have affected persons since the entry into force of the Term Service and Care Act (TSVG).1 2019 Entitlement to costübersahme by the health insurance.
In a woman of ideal age and good physical condition (which of course can be influenced by other factors), up to 15 eggs are retrieved per puncture, whereas in patients over 37, the number is often reduced to seven or eight. If the procedure has to be repeated for egg freezing, the total cost can quickly double.
What are the risks?
Apart from pain in the lower abdomen and possible side effects of hormone treatment (mild headaches, breast tenderness, slightly increased risk of thrombosis), there are no really serious health problems. In very young patients, in rare cases, there may be "overstimulation" with pain and water retention, but this rarely occurs in the hands of a doctor familiar with the method. According to our expert, the probability of this happening is two to three percent.
With expert advice from Dr. med. David S. Sauer, specialist in gynecology, obstetrics, gynecological endocrinology and reproductive medicine from the Kinderwunsch- & Hormonzentrum in Frankfurt am Main.
–1Guideline for the cryopreservation of egg or sperm cells or germ cell tissue as well as corresponding medical measures due to germ cell damaging therapy (Cryo-RL), Joint Federal Decision