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Dr. Gia Pastorfide had been seeing patients dealing with infertility for years. Her father, after all, was one of the pioneers of In-vitro Fertilization or IVF.
But in the pandemic, the director of Victory ART Laboratory Philippines Inc. noticed a new trend: Women wanted to know about egg freezing. This gives them the possibility to store eggs at a younger age for use in the future.
“We all know that our biologic time clock starts ticking when you reach the age of 35,” says Pastorfide, who is an obstetrician subspecializing in Reproductive Endocrinology and Infertility. “Starting at age 35, the egg quality and quantity start going down.”
“So especially that population of women, when the year started going past them and we’re still in the lockdown, they weren’t able to date, meet other people, and the older generations by that time they’re already married, right? So I guess they all got worried. And with the rise of the use of TikTok, people became more aware of it.”
These days, women who want to have children but don’t have a partner yet, or those who want to focus on their career for now, go to her to undergo this procedure.
There are also medical reasons for doing so. Patients who have newly diagnosed cancer will have their eggs frozen before undergoing chemotherapy, because the latter “attacks the cancer but also the normal tissue in the body, so it can affect the quality of the eggs,” Pastorfide explains.
What is egg-freezing, anyway?
According to UCLA Health, egg freezing, also known as oocyte cryopreservation, “is a process in which a woman’s eggs (oocytes) are extracted, frozen and stored as a method to preserve reproductive potential in women of reproductive age.”
When the patient is on the second or third day of her menses, she is ready to undergo the treatment, which takes around two weeks.
Explains Pastorfide, the process begins with ovarian stimulation, where the patient is given artificial hormones through injections on the belly, orally, or both.
When women ovulate or release an egg, they usually produce only one egg a month. There are also women who are anovulatory, especially those with irregular menses, who don’t produce eggs every month.
These exogenous hormones (“exogenous” meaning out of the body, or artificially produced, as opposed to “endogenous”, when you are producing it naturally or by yourself) help the patient produce more eggs.
These hormones also cause the ovary to produce many follicles, which house the eggs. The follicles are what the doctors monitor during the treatment via ultrasound, because eggs cannot be seen by the naked eye.
The injections are then given to the patient for ten to twelve days. Patients can also do this on their own.
When the follicles grow to around 1.8 to 2 centimeters, the eggs are ready to be harvested, says Pastorfide. This process is done through a minor surgical operation in an outpatient clinic.
Egg retrieval
A long needle is attached to a transvaginal probe (for a transvaginal ultrasound), and the instrument is then inserted into the vagina. Some centers sedate the patient during this process, while others do not.
The needle is then directed towards the ovary, then punctures the ovary, then each follicle, aspirating its contents. (“Sisipsipin.”)
“It’s a very quick procedure,” says Pastorfide. “Tumatagal lang siya kung sobrang dami ‘yung mga follicles ng patient. So lahat ng big follicles, the big enough sized follicles, we will try to aspirate because the goal really is to obtain as many eggs as possible."
(“It only lasts long if the patient has a lot of follicles. So all the big follicles, the big enough sized follicles, we will try to aspirate because the goal really is to obtain as many eggs as possible.”)
The contents of the follicles will then be transferred into a test tube, which will be brought to the laboratory for the embryologists to look at under a microscope to see if there are eggs inside.
The eggs are then frozen via vitrification, which Johns Hopkins Medicine explains is “a method of quickly putting eggs into a deep freeze.” The institution adds, “They’re stored in liquid nitrogen tanks in an embryology lab.”
When the patient decides she is ready to use their eggs, they will be thawed in the laboratory, says Pastorfide.
“The thawing process is rapid and is carried out on the same day the eggs will be fertilized and must be synchronized with a woman’s cycle. Over 90% of frozen eggs, on average, survive the freeze-thaw procedure,” she explains.
“Thawed eggs are next fertilized in our laboratory using a technique called Intra-Cytoplasmic Sperm Injection (ICSI). A single sperm is injected into the center of each oocyte. On average, about 60 percent to 70 percent of the injected eggs will be expected to fertilize normally.”
Once fertilized, Pastorfide further explains, the embryos will be cultured in the laboratory for two to three days, where they grow and divide. Not all embryos will survive. Those that do are transferred into the uterus using a small catheter guided by ultrasound imaging.
The cost of egg freezing
A patient can expect to spend anywhere from P300,000- P500,000 for egg freezing.
“Most of the cost is dependent upon the dose of the medications,” says Pastorfide. “So that dosage of medication depends upon many factors. If you would be using less medications, that would be cheaper.”
She adds that it is more cost-effective to freeze one’s eggs at a younger age—before 32 years old, to be exact, according the study “A SART data cost-effectiveness analysis of planned oocyte cryopreservation vs IVF with PGT-A considering ideal family size” by Bakkensen et al. in November 2022.
(Note this study compares those that have undergone egg freezing under 32 years old with those who did not do egg freezing and did up to three cycles of IVF in their early 40s—“a type of fertility treatment that involves retrieving a woman’s eggs from her ovaries, fertilizing them with sperm, and transferring the fertilized egg back into her uterine cavity,” according to Victory ART Laboratory Philippines—with “preimplantation genetic testing for aneuploidies.”)
“It’s synonymous to canning fruit. When do you can fruit? You try to can fruit when it’s at its prime,” says Pastorfide. “Theoretically, as long as you are menstruating, you will still be able to produce and harvest eggs. The question is though, is that egg still good?”
There are also side effects, which the patient may already be familiar with.
“When the follicles start growing, patients would frequently complain of bloating, vague abdominal pain,” says Pastorfide.
The enlarged ovaries go back to normal once the patient gets her menses again after the treatment.
“And these are… exogenous hormones. So it’s like taking the pill. So some women would have headaches, breast tenderness. They become moody or sleepy,” she adds.
There is pain on the injection site, as well, especially since the injections happen daily.
What will the child be like?
The first baby born from a frozen egg turns 40 next year.
But what do we know about humans who came from frozen eggs? According to UCLA Health, “Available data comparing births resulting from previously frozen oocytes with those from fresh oocytes have not shown an increased risk of congenital anomalies. More long-term data, however, will be needed to further assess these risks.”
Pastorfide offers another perspective: Who can afford procedures such as egg freezing and IVF? These are people who are usually well-off.
“So of course when they get pregnant, they enroll their children everywhere. There are so many avenues for fostering talent and whatnot. So the kids are comparable [to those from normal births],” she says.
There is nothing like the fulfillment Dr. Pastorfide feels when she tells a patient that she is pregnant. And for the women who wish to postpone pregnancy for one reason or another—and can afford this option—egg freezing gives them the hope that they can be mothers at the right time. — LA, GMA Integrated News
