The topic of family planning is often so much more than meeting the right partner at the right time. In fact, today there are so many “to do’s” in the period between twenty and forty  – starting with vocational training, followed by the right job and starting your own career. Perhaps larger trips are planned and if the soulmate is found, you might want to build your own home first.

With all these tasks, you can quickly lose sight of the fact that from a purely biological point of view, the optimal time to have children is in the (early) 20s. And in today’s society this means the vast majority of people are not ready and looking to have children at this young age. Of course, the chances of pregnancy do not decrease suddenly, but gradually. The chance of a spontaneous pregnancy in the mid-30s are only about half as high as in the early 20s.

For women in their early 40s, an age at which the most people today are rightly still quite young, pregnancies occur only in exceptional cases. In addition, there is the risk of miscarriage, which increases steadily over the years. For a woman in her early 40s, the chances of this happening is at about 30%.

The main reason for this adverse influence of age on fertility is mainly due to the increasing rate of oocytes with chromosomal disorders (problems in the distribution of the genetic material). While in women in their early 20s only about every tenth egg cell has a chromosomal disorder, such problems are found in a 40-year-old in almost 90% of all oocytes. This often leads to miscarriage and, less frequently, to childbirth of viable but conspicuous children, e.g. with Down syndrome.

In each fertile month, about 5 -15 follicles get into maturation and only one, the most dominant follicle, matures -which then bursts (“ovulation”) and releases the egg ready for fertilization. However the remaining follicles of the monthly cohort, which normally do not mature, can also be matured by hormone treatment as part of fertility treatment, so that in these cases significantly more than a single egg cell may be available. With the help of the so-called ovarian stimulation (very carefully dosed tablets or hormone injections) several follicles are matured and are able to be retrieved out of the ovary. 

The number of follicles that mature monthly (cohort) varies among women. The more follicles jump into the “monthly race”, the more eggs can be matured by the hormonal stimulation treatment and then are available for future fertilization which increases the chances of a prospective pregnancy. The average size of the monthly cohort decreases with age but can also vary significantly within women of the same age.

There are a number of factors determining this ovarian reserve, some of them cannot be influenced, such as familial and genetic ones. Assessment of ovarian reserve is therefore important and for this purpose, the gynaecologist has two main options at his/her disposal:

-At the beginning of the monthly cycle, ultrasound can be used to clearly visualize and count the maturing follicles, resulting in a good estimation of ovarian reserve called the “Antral Follicle count”.

-This works similarly well with a hormone value, the AMH, which is formed by immature follicles and enables a good estimation of the ovarian reserve.

Scientific advances in cryopreservation opened the door to the exciting possibility to freeze unfertilized eggs for a woman for future use. Today this is not just a ‘possibility’ but egg freezing has become a routine procedure in IVF clinics. But for many young women this allows them to elect to freeze their eggs for ‘social’ reasons. Thus to maintain the “rush hour” of  life and to have more time left for training, career, traveling and partnership.

From a biological point of view, the most favourable phase for freezing eggs is in your 20s and early 30’s. At a young age, it is usually very easy to mature a larger number of chromosomally intact eggs and retrieve them out of the ovaries. But we have the option to retrieve and freeze eggs (with some limitations) practically at all ages. And for many women who consider the option they will often be mid to later 30’s. While less biologically ideal this still offers good odds of protecting the future. Granted it may require more than one egg retrieval cycle to store the optimum number.

After retrieval the eggs are prepared and vitrified at -176°C. At these temperatures, all aging processes are stopped. So the eggs are kept permanently at the chromosomal and biological make-up at the time of the sampling. When the time is right, the woman can chose to proceed with thawing of the eggs and fertilizing them and forming into embryos. One, to a maximum of two embryos are transferred back in the uterus and hopefully implant and lead to a healthy pregnancy. Depending on different factors, pregnancy rates of about 60% can be achieved per embryo transfer. This procedure has already been used millions of times for women with an unfulfilled desire of having children.

It is safe and low risk.

If you are interested in freezing your eggs, please reach out to us here.

– Dr Dziura