The topic of today’s interview with Luciano Nardo, MD MRCOG, Clinical Director at Reproductive Health Group, and Caroline Watkins, Senior Embryologist, is egg freezing. If you are looking for information on oocyte freezing in the UK, this interview will provide all you need to know before you visit the clinic and undergo the procedure.
Reproductive Health Group was opened in 2014 and it provides various fertility treatments and women’s health care for patients from the UK and abroad. At this clinic, every woman has the opportunity to start a family at whatever point in her life she wishes to. RHG specializes in social egg freezing that allows women to save their eggs for the future, making the most of their fertility here and now. If you are thinking of freezing your oocytes, this article is exactly for you. Watch the video interview above and read the transcription of the questions and answers of the experts. Also, check the details of the free egg storage offer at the bottom of this post.
Patient selection and assessment – what tests should be done before egg freezing?
Luciano Nardo, MD MRCOG: Assessing the ovarian reserve and selecting the best population for egg freezing is of paramount importance. Chronological age per se is the main determining factor, however, assessing how the ovaries are in advance of controlled ovarian stimulation to collect eggs for freezing is important. We normally recommend that women have a blood test for the ovarian reserve marker AMH, which is a hormone produced by the granulosa cells within the follicles, and also have an ultrasound scan to assess the number of antral follicles which are follicles that measure between 2 and 6mm seen within the ovaries at the beginning of each menstrual cycle.
The combination of AMH levels and the antral follicle count in addition to the chronological age will help us to determine if the female patient is suitable for undergoing the egg freezing programme. Patient selection is not just something we can sometimes choose, as egg freezing is also recommended for medical reasons and that may be in women who have some underlying health issues for which medical cryopreservation of eggs is recommended.
How do you collect the eggs?
Luciano Nardo, MD MRCOG: Egg collection is a straightforward procedure, it’s done in the procedure room and within our clinic, we perform the egg collection under sedation. It takes about 15 to 20 minutes and we have a consultant anaesthetist present in the room together with a nurse assisting the clinician while collecting the eggs. We use a transvaginal approach so a transvaginal ultrasound probe is used and on top of this, we will slide a needle holder and the needle holder is obviously used to guide the needle into the ovaries. Each ovary is visualised under ultrasound scan and then eggs are normally one per follicle collected and put into a plastic tube which is passed on to the embryologist for assessment under the microscope.
What would be the best protocol for stimulating the ovaries before harvesting the eggs?
Luciano Nardo, MD MRCOG: There is no single protocol that is good for everyone and in the fertility field we have moved away from one size fits all. It is important that we take into account the female chronological age as well as the ovarian reserve marker, both AMH and antral follicle count, in order to determine which protocol is most appropriate to achieve the safest and most effective response to stimulation. Assuming that most women embarking on egg freezing are young, fit, fertile and have a good ovarian reserve we would be using a short antagonist protocol which has been known to assist a satisfactory follicular development as well as reducing the risk of ovarian hyperstimulation syndrome.
Is there is a benefit to counselling before egg freezing?
Luciano Nardo, MD MRCOG: Most women that will be embarking on an egg freezing programme are likely to be single, perhaps very career committed and perhaps not in a position to think about starting a family in the immediate future, so they may be having some questions that are better answered by an independent fertility counsellor. They require a significant degree of information and sometimes digesting that information on their own may also not be good. We always encourage women to talk to family members and friends but in case they prefer to discuss with a third party, an independent person, we offer support counselling within the clinic.
How do you assess the eggs that have been harvested and suitable for cryopreservation?
Caroline Watkins: So as Mr Nardo said the follicular fluid comes through to the lab and we put this under the microscope and we find eggs present in that fluid and we culture it for a time. We then take away the big cloud of cells that are present naturally around the outside of the egg and again we put the eggs under the microscope and assess them for their maturity. We are looking for a structure called a polar body to indicate that the egg is mature and those eggs will be selected for vitrification.
How do you actually freeze the eggs?
Caroline Watkins: As I just said we use vitrification to freeze eggs and it’s a process that involves the use of cryoprotectants. The eggs are exposed to the solutions in a stepwise manner and it dehydrates the egg and then actually rehydrates with a cryoprotectant incorporated into the egg and these eggs are then loaded on to a vitrification device and plunged into liquid nitrogen. This is done in such a way that eggs avoid going through a critical temperature change which in the old conventional method of slow freezing led to ice crystal formation and led to eggs, unfortunately, dying as a result of that freezing process.
How long can eggs be frozen for?
Caroline Watkins: I think from a technical point of view they probably could stay in storage for a good hundred years as long as somebody is topping up the nitrogen and keeping them at the right temperature. However we are governed by the HFEA in this country and the guidelines state that it doesn’t matter who you are, what age you are, you have a statutory right to store for up to 10 years in this country. There is the possibility to extend that storage if you are deemed as prematurely infertile near the 10 year anniversary and you can extend in potential 10 year blocks up to 55 years as a very maximum.
What advice would you give to women who want to use frozen eggs?
Luciano Nardo, MD MRCOG: I think that any woman that has got frozen eggs and decides to use those eggs has to think about the financial, emotional and physical implications of embarking on a pregnancy first. We don’t believe that egg freezing should be seen as an employment benefit or indeed an insurance policy as in that case some women may think about delaying motherhood to concentrate on other things in their best fertile years. But if the use of the cryopreserved eggs is needed I think the first thing to bear in mind is whether the woman is healthy at the stage that she wants to use the eggs. Second is why using the frozen eggs if she could perhaps attempt to conceive naturally obviously provided she has got a partner she is in a relationship with. Three, what would be the consequence of using the frozen eggs? We know that there might be some reasons or the woman may have had some medical problems for which the use of frozen eggs is the only avenue to have a family in the future but if not we would recommend trying to conceive naturally or trying to use fresh eggs if there is a need to embark on assisted conception would be the preferred option. We also recommend that before using frozen eggs if that is required the woman has a full understanding of the fertilisation as well as the embryo creation and embryo transfer, so to have realistic expectations of the process and the chance of success.
Are there any pregnancy-related risks to using frozen eggs?
Luciano Nardo, MD MRCOG: There are no reports in the literature to suggest that the use of frozen eggs increases the pregnancy-related problems, that being both maternal and fetal issues in pregnancy. However, we know from some egg donation studies where frozen eggs have been used that there is an increased risk in pregnancy but this is likely to be associated with the use of the donor eggs rather than the with the freezing of the eggs.
What are the organisational synergies for running a successful egg freezing programme?
Luciano Nardo, MD MRCOG: A successful egg freezing programme relies on a well established and consolidated multidisciplinary team and unlike many other areas of medicine we know that the provision of fertility services is not just one speciality. We are very fortunate at the Reproductive Health Group as we can rely on excellent expertise and skills in the lab and we also have a highly committed team of nurses. We have independent counsellors and also some care coordinators that put patients interest and wellbeing at heart so when we look at a successful egg freezing programme we have to make sure that a clinic can offer the clinical, the laboratory and the nursing aspects of treatment to ensure that that patient feels supported, understands fully the implications but also she is satisfied based on the information provided that the eggs will be cryopreserved using the best and the most up to date technology and that those eggs once they need to be defrosted or thawed they will be used as well using some standard laboratory processes and we know that the success of the treatment itself is not just dependent on the protocol that has been used, employed, recommended, but is very much on the commitment as well as the ability that the eggs have to survive after the thawing process which is very much dependent on the freezing itself.
Is there anything you would like to say in conclusion?
Luciano Nardo, MD MRCOG: I think what I would like to say in conclusion is that anyone thinking about freezing eggs should seek information from the clinic, should rely on a service that has got an established egg freezing programme, should have the opportunity to ask questions to the clinical and scientific team and should also have an understanding that freezing eggs at a later stage in life is not the best option. Eggs should be cryopreserved as early as possible during reproductive life if those eggs will be used or can be used in the future. We also need to be aware at the moment in the UK that the 10 year storage period is something that has to be borne in mind when the decision about freezing eggs is made as a woman that is going to freeze eggs at the age of 25 has potentially got 10 years to use those eggs which makes her 35 and may be still in her career life or work environment and not made the decision about starting a family. So the information, the counselling, the clinical care and the nursing support that women freezing eggs receive in my opinion is central to the successful programme.
Get 12 months of free storage at RHG!!!
Reproductive Health Group has a unique offer for FertilityClinicsAbroad.com patients: you can benefit from 12 months of free oocyte storage if you freeze your eggs at the clinic.
- Normal charges for storage will be applicable after the first 12 months.
- The offer is not to be used in conjunction with any other offer other than the free consultation for FertilityClinicsAbroad patients.
- The offer is valid from 01/09/2020 until 01/03/2021.
- RHG reserves the right to withdraw the offer at any time.
- The enquiries must be received via the contact form in the clinic’s profile. Go to the clinic’s profile now.