Social Freezing: procedure & chances of success
Egg freezing has been a common method in medicine to preserve fertility for a certain period of time. While in the past it was primarily intended for women who had their healthy eggs frozen due to cancer and pending chemotherapy, today it is also a popular alternative for flexible family planning for private, professional or financial reasons. More and more women are using the option of social freezing to be able to become pregnant at a later date by creating a “fertility reserve”.
What is Social Freezing?
Social freezing, also known as cryopreservation in medical terminology, refers to the precautionary process of harvesting and then freezing unfertilized eggs without medical necessity. With this method, women can prevent their age-related loss of fertility and fulfil their desire to have children at a later date by “thawing” the eggs again.
How does social freezing work?
Usually, the process of social freezing begins with the first consultation at a fertility clinic. Preliminary medical examinations then take place on site. After hormonal stimulation, several eggs are removed during the cryopreservation then shock-frozen (vitrification) and stored in the laboratory for a very long time.
Step 1: Preliminary examination
After a detailed preliminary discussion with experts, with reproductive physicians or fertility doctors, the next step is a preliminary medical examination using blood values (hormone balance) and ultrasound. The doctor will check whether the necessary requirements for social freezing are fulfilled (probability of success / chances) and inform you about possible risks of the treatment. Other uncertainties can be clarified in advance by a specialist.
Step 2: Preparing for hormonal stimulation
If you meet all the requirements after the preliminary examinations, a date will be set for the start of the stimulation. The plan for both the duration and dosage during the hormonal stimulation of the ovaries is drawn up in advance together with the doctor. As the corresponding medication is only available on prescription, you will receive a doctor’s prescription with professional instructions. Schedule enough time to receive the medication (usually injections) to be able to start on time.
Step 3: Hormonal stimulation
During a certain period of time, which often lasts between 10–14 days, you inject the prescribed hormone preparation at home. The hormonal stimulation should lead to as many eggs as possible maturing by the time of retrieval. In order to monitor the growth of the follicles and keep an eye on the hormone levels, regular check-ups are carried out via ultrasound and blood sampling. This also helps to determine whether the dosage should be changed and identify the perfect time to retrieve the matured eggs. After this determination, a hormone is injected once (“trigger shot”) to trigger ovulation. Once ovulation has been successfully triggered, the doctor can begin the collection procedure.
Step 4: Retrieval of the eggs
In order to retrieve the matured eggs, you will have to go to your accompanying fertility clinic (usually one day) after the last injection. You will be examined again and informed about the next steps. After a medical consultation, you will then be taken to an operating theatre where the retrieval will be carried out under a short anesthesia. The procedure is usually minor and only takes about 15–30 minutes. During this time, the doctor removes the follicles from the ovaries by so-called “vaginal follicle puncture”. Follicles, which contain a mature egg, are “sucked out” through a very thin needle. Following this short process, you will be taken to a quiet room to wake up and rest until you are ready to go home. For your own safety, you will need to be picked-up by a person of your choice due to the (albeit short) general anesthesia.
Step 5: Freezing (vitrification) of the eggs
After the follicles have been collected, a specialist biologist will examine how many of them contain a mature egg. Suitable oocytes are then frozen within a few seconds at ‑196°C (“shock freezing”). Medically, this procedure is also called “vitrification”. This method offers many advantages, as on the one hand it does not damage the cells and on the other hand has a very high, almost risk-free “restoration rate” (98%).
Step 6: Storing the eggs
The good thing is that you can safely store your vitrified eggs for several years, even decades. The greater the number of eggs stored, the greater the chance of pregnancy at a later date and thus of fulfilling your personal wish to have a child.
When the time is right for you, the eggs are thawed again and can then be fertilized.
What are the chances of success?
Chances of success
Both the quantity (“egg reserve”) and the quality of the eggs do not develop linearly with age. To better understand the chances of success with social freezing, it is worth recalling the procedure: After hormonal stimulation of the ovaries, the eggs are removed and then frozen at minus 196 degrees Celsius. Accordingly, there are two main steps in this process that determine the subsequent likelihood of success of a pregnancy from cryopreserved eggs: 1. the retrieval and 2. the freezing of the eggs.
One of the most important statistical factors for success is the age of the patient at the time of egg collection. This is because the quality of the eggs decreases with increasing age — in medical terms, this is referred to as the “euploidy of the cell organisms” decreasing.
In addition, the natural egg reserve decreases with increasing age, which is why more cycles are needed to obtain the same number of eggs. A critical age regarding the oocyte reserve is often seen at around the age of 35, since from this point onwards the rate of natural births decreases disproportionately. In general, it is recommended to retrieve at least 10–20 eggs for social freezing. According to a 2017 study of 520 ICSI cycles, women aged 34, 37 and 42 have a 90%, 75% and 37% chance of at least one successful birth with 20 frozen eggs, respectively. A 20-year-old woman even has a 94% chance with 20 frozen eggs.
Desired number of births
Similarly, one can consider the case where patients desire multiple births based on the frozen eggs. Again assuming 20 frozen eggs are stored, a 34-year-old woman has a 66% chance of having at least 2 births. For a 42-year-old woman, on the other hand, the chance is only 7%.
If at least three live births are to be achieved, the probability of a 34-year-old woman decreases to 38%; the probability of a 42-year-old is about 1%.
Therefore, a clear correlation can be demonstrated between the age at the time of egg retrieval and the probability of success of a subsequent pregnancy from social freezing. It should be noted, that these are statistical values which in practice vary from person to person. Similarly, regardless of age, there is no guarantee of success with social freezing for a subsequent pregnancy.
There are also further differences in success rates due to the method of freezing the eggs. A distinction is made here between so-called “slow freezing” and vitrification. The two methods differ primarily in the speed with which the eggs are frozen.
In slow freezing, the retrieved oocytes are cooled by about 2 — 3 degrees Celsius per minute over a longer period of time until they reach the required minus 196 degrees Celsius. This low final temperature is necessary to stop the biological processes in the oocytes and make long storage possible without loss of quality.
In vitrification (also called “flash freezing”), the eggs are immersed in liquid nitrogen, which allows them to be frozen at minus 196 degrees Celsius within minutes. For egg freezing, speed is a crucial success factor: eggs largely consist of water, which is why it is important to prevent crystallisation of the liquid during freezing. Accordingly, vitrification is clearly the more promising method, which is why it has become widely accepted in recent years .
In summary, the age of the woman, which is ideally below 35 years, in combination with the method of freezing (vitrification) are decisive factors for increasing the probability of success of a subsequent pregnancy through social freezing.
Use of the oocytes
You can decide for yourself if and when you want to thaw the eggs for use. If you cannot get pregnant naturally, assisted reproduction (IVF or ICSI) is possible. This involves fertilizing the eggs with the man’s sperm cells. Once cell division has begun, the fertilized egg can be inserted into the uterus. Despite the high probability of success of achieving a pregnancy with the help of social freezing even at a late age, there is no guarantee of an uncomplicated family formation. Complications can occur for a variety of reasons, which is why specialist care is always recommended.
What are the risks of social freezing?
Social Freezing is associated with few risks and is rather harmless. Apart from the increased likelihood of a multiple pregnancy with assisted reproduction, there are still possible complications that pregnancy at an older age can bring: increased susceptibility to gestational diabetes or high blood pressure.
At the same time, some risks are eliminated or greatly minimised in a pregnancy resulting from social freezing if the eggs were cryopreserved at the youngest possible age: genetic malformations or high risk of miscarriage due to age.
Reasons for Social Freezing
When American companies like Facebook and Google announced in May 2014 that they would pay for the social freezing treatments of their female employees, it made big waves in Germany. It was the beginning of a social debate: To what extent should young women be encouraged to put their careers before family planning, and to what extent is it permissible to help them do so medically?
Although there was a lot of media attention around the topic, most of the articles missed the real truth with their central thesis — social freezing is mainly something for career-oriented women. In a 2013 study, women were asked why they had their eggs frozen (multiple answers were possible). Contrary to the common assumption that social freezing is primarily done for career motives, only 24% of the respondents gave this as a reason. A significantly larger proportion of respondents, namely 88%, stated that they currently did not have a suitable partner for having children. 15% gave financial reasons or named a too high burden as a reason for postponing the child wish .
Another motivation for social freezing that is often neglected: In certain cases, cancer patients have their eggs frozen before chemotherapy in order to have them fertilized in case they want to have children later. This variant is also called medical freezing.
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