The Royal College of Obstetrics and Gynecology (RCOG) recently draw the attention of In vitro fertilization (IVF) experts on a very salient observation that egg freezing had tripled in five years. RCOG also stated that a large number of those who go for egg freezing are over 37 years and these group of people have lower chances of success when they would need the eggs. This, researchers have linked to the fact that more women now postpone raising families due to many social factors including educational/career pursuits and the unavailability of the right partners.
While the reason for the postponement is crucial, age may not be on their side because age decreases fertility by decreasing both quality and quantity of the eggs present in the ovaries of women. The only hope for these women therefore is egg freezing which helps to put the “physiological clock” on hold. However, the right people are not going for it as revealed by Dr. Timothy Bracewell Mines, who reported the experience both at the Imperial College and Chelsea and Westminster Hospital, London in a review of 1,173 egg freezing cycles in 2016.
The result showed that only 32 per cent of the women were 35 years or below. This also confirmed that even in the United Kingdom, women are using egg freezing as a last resort instead of a planned and informed choice in their early to mid-thirties.
The implication of this is that women in their late thirties would need about 30 eggs stored to have a good chance of achieving pregnancy due to lower success rates per egg with increasing age in women. To achieve this number of eggs, these women would probably need to undergo an average of three cycles of ovarian stimulation! In addition, they also have to contend with the storage fees together with the cost of fertility treatment using their frozen eggs in the future. If social freezing in its present usage, is not the silver bullet, what then should we be doing? The managing director, Nordica Fertility Centre, Dr Abayomi Ajayi, in an interview with LEADERSHIP, said, “We have a brilliant technology in the present method of egg freezing – vitrification. Continuing, he said: “All that is needed is a little modification in its application. Meanwhile, a lot of emphasis and effort need to be placed on fertility education.” Using his experience in Nigeria, Ajayi said he noticed that many people who come for enquiries about egg freezing are not suitable as many of them are in their 40’s and only want to use it as a “last ditch effort”.
He said, “They should have done it 10 years ago. I even met a 50 year old woman who claimed she just stored her eggs in one of the clinics that is not even a fertility clinic! “The age at which you froze your eggs would depend on the success rate of it becoming a baby. If you are 40 years old and you need to freeze your eggs, you would need to freeze about 30 eggs for you to have a good chance of having a baby from the eggs that you have frozen. “While that may be possible, it is not easy for a 40 year old lady to have 30 eggs, that means she has to do about five IVF cycles. That is why people need to understand the technology and how to use it because freezing eggs is not a guarantee that you will have a baby later when you are more than 35. That is why the IVF experts would need to educate his clients on the process from the onset.”
On the other hand, Ajayi said maximum benefits of egg freezing would come from when one is less than 35 years because that is when she is most fertile, adding that for her to be able to freeze and have a good chance of success, she would need to freeze about 15 to 20 eggs.
The managing director said in the U.K, egg freezing is limited to a 10 year duration for now. If the aforementioned are facts, he said the RCOG sounded that caution to prevent positing a “one sided” story and portray egg freezing as a silver bullet or magic wand for postponing fertility.
“The technology is not the problem, it is the quality of what you are freezing. Over the years, the number of people who freeze their eggs are very low and I think awareness, the fact that a lot of people think that the process may be very expensive, and the fact that people are not even thinking about it are the main reasons for the low rate.”
Speaking on ways to avert the trend, Ajayi said, “People need to start reading because that is the only way they can be informed. One thing people should understand is that when you store your eggs when you are less than 35 years, you can still use it when you are 45 years and the process is something they can afford. “With that, you can actually beat time when it comes to fertility and achieve whatever you want to achieve and then use your own eggs when you are ready to have a baby.” Another way to tackle the low awareness, according to Ajayi is to bring the religious and traditional people into the fold as they need to understand what IVF process is all about. “Also, more emphasis needs to be placed on educating girls and women on how to achieve their fertility potential naturally, bearing in the mind the natural decline in fertility as they make life decisions.
“They need to understand the risks of age-related complications in pregnancy, child birth, miscarriage and still birth rates,” he added
He said practitioners of reproductive health should furthermore place emphasis on factual education of their clients on the limitations that age has an outcome of fertility treatments including IVF. He however said there is no doubt that the present dilemma of egg freezing is not with the technology but the fact that it is not getting the attention of the women who can get its maximum benefit, adding that it is currently being used by older women as a last ditch effort than a well planned intervention. He said, “Vitrification offers single women an extension of the window of opportunity to put the dreaded “physiological clock” on hold!” In the same vein, Professor of Reproductive Medicine and Spokesperson of the RCOG, Adam Balen, said success rates of egg freezing have improved significantly in recent years, to offer an opportunity for women to freeze their eggs for social reasons, if they are not ready to have children yet. However, Balen said it must be stressed that egg freezing does not guarantee a baby in the future.
He said, “While women should be supported in their choices, they must be informed about the side effects associated with egg freezing and IVF treatment. “If a woman decides to freeze her eggs for social reasons, she should have counseling with a reproductive specialist and choose a clinic that has extensive experience. Evidence suggests that the best time to freeze eggs is in a woman’s early twenties and certainly under the age of 37 years.”
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