Egg Freezing: How Women Can Achieve Motherhood on Their Own Terms

This week, amidst a barrage of constant news about the ongoing global pandemic, came a ray of sunshine—supermodel Naomi Campbell made a surprise announcement about the arrival of her first baby at the age of 50.

In an Instagram post on 18 May, the former British supermodel, actor, entrepreneur revealed:

"A beautiful little blessing has chosen me to be her mother.”

While congratulatory messages poured in from the who’s who of the glamour world, the news also served to give hope to the millions of older women who dream of achieving their goal of motherhood on their own terms and when they are ready for it.

Back in 2017, Naomi dropped a massive hint about her plans to have a baby, when she said in an interview:

"I think about having children all the time. But now with the way science is I think I can do it when I want."

Thanks to a combination of science and technology, women today have a plethora of options, from egg-freezing to in vitro fertilization (IVF) treatments to surrogacy, when it comes to prolonging their fertility.

This also means that an increasing number of women no longer need to worry about the proverbial biological clock ticking away.

Several stars from Sofia Vergara, Emma Roberts, Chrissy Teigen, Khloe and Kourtney Kardashian, to closer home, Diana Hayden and Mona Singh have openly spoken about having opted to freeze their eggs—a decision that gives them the freedom to choose when they can have a baby, as well as the freedom from societal pressure to find a partner and settle down or compromise on their careers.

Silicon Valley giants such as Facebook and Apple are paving the way by even covering egg freezing procedure as a part of their insurance benefits.

As life and relationships can be unpredictable, freezing of your eggs, sperm or testicular tissue has become an acceptable way for men and women who may wish to keep their options open in terms of reproduction.

“You are independent, strong and want to be a mother some day. Now – for whatever reason – is just not the right time.”

“Freezing your eggs offers a way to keep your options open, preserve your fertility and take charge of your reproductive health,” explains Dr Rishma Pai, consultant gynaecologist, Jaslok and Lilavati Hospital, as she explains the procedure and what to expect from it.

How To Freeze Eggs?

The egg cell – also known as the oocyte or ovum – is the female gamete (sperm are male gametes). The egg cell is a large human cell, is almost perfectly round and contains a great deal of cytoplasm.

The egg develops in one of the woman's two ovaries.

Ovulation occurs when a mature egg is released from the ovary, travels down the fallopian tube and is available to be fertilized by a sperm.

When the oocyte is fertilized, it is capable of becoming an embryo, attaching to a woman's uterine lining and developing into a healthy pregnancy and live birth.

Scientists' understanding is that a woman is born with a finite supply of oocytes, and as she ages, her egg supply dwindles until she has no more. This is when she enters menopause.

Ovarian reserve is a term that refers to the quantity and quality of the eggs a woman has left. Egg quantity and quality begin to decline in the mid-30s, and then start declining at a faster rate in the late 30s and 40s.

There are screening tests for ovarian reserve, which are required prior to freezing eggs.

These tests may include:

• Day 3 follicle stimulating hormone (FSH) levels test
• Estradiol levels test
• Clomiphene challenge test
• Anti-Mullerian Hormone (AMH) levels test
• Ultrasound for an antral follicle count

These tests can help determine which ovarian stimulation protocol would be most effective so fertility experts can retrieve the most eggs possible.

Egg Freezing Process

The first step in the egg freezing process is to find a fertility clinic near you that has expertise in and a history of successful egg freezing. Egg Freezing Authority can help you with this step.

Once you find the right fertility clinic for you, you will have testing to evaluate your ovarian reserve.

This involves blood tests to measure hormones, as well as an ultrasound for an antral follicle count. The number of antral follicles visible on ultrasound indicates the relative number of microscopic primordial follicles that remain in the ovary. For example, a young woman under 30 with 10 follicles per ovary has a good chance of success with egg freezing.

You will also have a consultation with the medical team involved in egg freezing who will explain the procedure to you. You will be given information and forms so that the fertility clinic will have informed consent.

Then the treatment process begins. Each woman's treatment protocol is individualized to maximize egg production.

However, all follow similar steps.

• Ovarian stimulation

You will start fertility drugs based on your individualized treatment protocol. This typically involves injectable fertility drugs that you will administer daily. These medications stimulate the ovaries to begin the growth of multiple healthy eggs. You will take these medications for eight to 12 days.

• Monitoring

While taking fertility drugs, you will visit the fertility clinic every few days for blood tests and monitoring with vaginal ultrasound to assess your follicle growth.

• Trigger shot

Once your ovarian follicles have attained a sufficient size, and your blood level of estrogen is adequate, you will probably take an intramuscular injection called the "trigger shot". This prepares your eggs for retrieval.

• Egg retrieval

Approximately 12 days after beginning medications and 36 hours after the "trigger shot," the eggs are ready for retrieval. You will receive some kind of anesthesia, and the fertility doctor will use an ultrasound-guided hollow needle, which is inserted through the back wall of the vagina up into the ovaries. The needle is used to aspirate (suction out) any follicles that may be present in the ovaries.

• Egg freezing

After the egg retrieval, the eggs are prepared for freezing using vitrification. They are transferred to a liquid nitrogen storage chamber, where they are stored in the frozen state until you are ready to thaw them and use them.

(Dr Rishma Pai is an honorary consultant Gynaecologist at the Lilavati, Jaslok and Hinduja Health Care Hospitals, Mumbai and former president of FOGSI and ISAR.)