CRYOPRESERVATION

EGG FREEZING

Egg Freezing

Oocyte Cryopreservation(OC) is a process by which eggs are formed, extracted and stored for future use in a lady.
The lady undergoes a transvaginal ultrasound, evaluation of hormones and detailed counseling about the prospects in her particular case prior to starting the cycle.

FAQ

OC was originally introduced as a fertility preservation option for those women who were going to undergo surgical removal of the ovaries or chemotherapy treatment for cancer.
Here it is usually done as an emergency procedure as treatment for cancer will need to be initiated as soon as possible.

It is the same process of OC done as a planned procedure where the woman wants to preserve her eggs for social rather than medical reasons.
The better terminology proposed is OC for anticipated gamete exhaustion(AGE)
Unfortunately, the reproductive window is definitely shorter in women than in men.
The time period when fertility rates peak in a lady is also the same as when her education and career advancement are at a peak.
It gives women more reproductive choice and decreases the pressure they face from the “biological clock”

NO, the best option will always be less invasive methods and natural conception if it is a possibility.
It is important to counsel women that though OC is an option to consider, it can in no manner be looked at as an option which will provide a 100% guarantee of giving birth.
The chances of a successful outcome primarily increase with two factors;
A.The younger the age at which the eggs are frozen- women who freeze their eggs at less than 35 years of age have more chances of giving birth.
B.The more eggs that are frozen, the better the chances of pregnancy.
One latest study reported that if a woman less than 35 years freezes 10-20 eggs, she has a 70-90% chance of having at least one child from them.
At age 38 and above, a woman may need to freeze about 20-30 eggs to have a reasonable chance of having at least one live child.
This may increase the number of cycles needed to collect the same number of eggs as the age of the lady increases.

The main complication is risk of OHSS as our aim is deliberate hyperstimulation to get the maximum number of eggs possible.
The risk of OHSS can be minimized by ;
A. Using the antagonist protocol.
B. Using the agonist trigger and avoiding hCG trigger.
C. Using antagonist injections post ovum pick up.

With the advent of the vitrification procedure, the rates of survival after thawing have increased substantially.
Rates of fertilization, implantation and clinical pregnancy rates have been reported to be similar for both fresh and frozen oocytes.
But, the success rates may also differ with the expertise and experience of the person who does the vitrification.

As yet, there have been no increased risk of congenital abnormalities reported in children born from frozen eggs as compared to other IVF pregnancies.
But the data on long-term oocyte storage and long-term offspring health will be known only with time and increased use of the treatment.

FREEZING OF SPERM

The semen sample of the male partner is processed to remove the debris and separate the fastest moving sperms which are then frozen in liquid nitrogen for future use.

The semen sample of the male partner is processed to remove the debris and separate the fastest moving sperms which are then frozen in liquid nitrogen for future use.

Freezing of Sperm
  • In case of sperm donation in semen banks.
  • In men who have difficulty collecting samples at the time of IUI due to more stress and pressure to provide “on-demand”.
  • In men who are going to undergo treatment for cancer which may destroy their sperms.
  • As a routine in IVF cycles to have a backup sample in case the husband is not available on the date of pick up or is unable to collect on that day.
  • As a safety precaution in men whose counts are subnormal, when they decide to wait or try other alternative treatment options in the hope that the counts may improve
  • In couples where the husband is stationed overseas for long periods but they want to continue treatment with a few cycles of IUI.
  • In all cases where sperm has been surgically retrieved as in after PESA, TESA or TESE.

FAQ

It is essential to do a serology test before going ahead with freezing the semen sample.
He should be free from any active urogenital infection

Semen should be collected by masturbating into a wide-mouthed sterile container. Due to concerns with chances of infection, it should not be collected by sex and withdrawal method.

This is a fairly common problem as it is not always possible to masturbate on demand, especially in a bathroom or hospital setting where there is a lack of privacy.
Aids such as porn magazines, porn videos, use of a vibrator, or partner-assisted masturbation in a private room may be tried.
If it still fails to give results, we advise the couple to bring the sample from home provided the hospital is reachable within 30 min of collection.
In such cases, an additional consent stating that the sample brought from home is the husband's sample should be signed by both the partners.

There is no set time limit for the storage of sperm but the usual time frame stipulated is a period of ten years.
Sperms have been reported to have been used successfully even 40 years after storage!

Semen parameters prior to freezing will determine the parameters post thawing.
Sperm may undergo some damage during the freezing and thawing process due to osmotic or oxidative stress as well as the formation of intracellular ice crystals, which in turn may reduce the number of functionally normal sperms.
The process of cryopreservation must hence be carefully controlled to minimize the risk of damage.
One recent study reported that about 80% of sperms may survive the thaw.

Sperm can be stored for the purpose of donation only in ART banks registered under the provisions of this act.
Sperm can be donated only by a male in the age group of 21 to 55 years.
It is stored after testing the person for diseases outlined in the guidelines.
Sperm donated by one person can be used for only one commissioning couple in a lifetime and not more.

The number of samples we need to freeze will vary from person to person depending upon the reason for which it is done, the semen parameters, the treatment proposed as well as family building goals of the couple.
One semen sample may give up to four vials of sperm of counts normal.
One vial is used for one IUI attempt typically.
But for IVF/ICSI as even one vial may contain millions of sperms,even one vial should be sufficient.

The usual time period we collect a sample is a sex-free or ejaculation-free gap of 3 to 5 days, so samples can be collected with a gap of few days between them. But having said that, it can be collected at shorter intervals also if time is of concern, as in starting treatment for cancer.

EMBRYO CRYOPRESERVATION

EMBRYO CRYOPRESERVATION

This is the process of freezing embryos by a process called vitrification for intended long-term use in the future.

FAQ

Embryo freezing has been in common use since the 1980s and has been proven to be a safe and effective method, especially with the advent of vitrification.
There is a theoretical risk of embryos getting damaged or not surviving when thawed.,
As usually only good quality embryos are chosen to be frozen,the risk of damaging the embryos remains negligible in experienced hands.

There is no theoretical limit to the number of years where they remain viable but under the latest Indian law, storage is allowed for a period of ten years.

YES, World over there has been an increase in the number of frozen embryo transfers(FET) in the past decade.
Frozen embryo transfers are reported to give as good as and in many instances better pregnancy rates when compared to fresh transfers.

In case you have finished your family or do not want to renew storage for some other reason, you can choose to,
1. Discard the embryos.
2. Donate them for research or for training purposes.
This is usually covered in the consent form signed at the start of the process itself.

YES, Informed consent is taken from both partners before proceeding with freezing.
Consent is also taken about what to do in case there is the untimely death of one partner or in case of legal divorce.