INTRODUCTION:

Egg freezing, sometimes referred to as mature oocyte cryopreservation, is a technique used to preserve women's future fertility. Unfertilized eggs taken from ovaries are frozen and kept for later use. The practise of egg freezing, also known as mature oocyte cryopreservation, is used to protect women's future fertility. Unfertilized eggs removed from ovaries and stored for later use are frozen. It is feasible to use in vitro fertilisation to thaw a frozen egg, combine it with sperm in a lab, and implant it in the uterus.¹

Why is it carried out:

Egg freezing may be an option for a woman who isn't ready to become pregnant right now but wants to ensure she can in the future. Egg freezing doesn't require sperm because, unlike with fertilised egg freezing (embryo cryopreservation), the eggs aren't fertilised before being frozen. She will need to take fertility medicines to induce ovulation and produce several eggs that can be collected, just like with embryo freezing.²

She might consider storing her eggs if:

· She suffers from a condition or circumstance that could affect her fertility. Gender diversity, such as being transgender, autoimmune diseases like lupus, and sickle cell anaemia may be some of these.

· She requires medical care for cancer or another ailment that would make it impossible for her to get pregnant. Some medical procedures, like as radiation or chemotherapy, may damage female fertility. Thanks to egg freezing before treatment, she might be able to have biological children in the future.

· She had in vitro fertilisation. For ethical or religious reasons, some people prefer egg freezing over embryo freezing when they undergo in vitro fertilisation.

· She desired to preserve immature eggs for later use. If she stores eggs when she's younger, she might be able to get pregnant when she's ready.

Her frozen eggs and sperm from her husband or a donor can be used to try to conceive. A donation could be well-known or anonymous. The embryo can also be implanted (referred to as a gestational carrier) into the uterus of another individual to carry the pregnancy.³

Trouble related to egg freezing:-

Egg freezing carries with it the following risks:

o Using reproductive drugs can lead to the following diseases:

· Ovarian hyperstimulation syndrome, a rare side effect of injectable fertility drugs like synthetic follicle-stimulating hormone or luteinizing hormone, can cause your ovaries to enlarge and ache shortly after ovulation or egg retrieval. Some of the warning signs and symptoms include abdominal pain, bloating, nausea, vomiting, and diarrhoea. A more severe, maybe fatal, variation of the sickness is considerably less likely to develop.

o Obstacles to egg retrieval include:

· When removing eggs with an aspirating needle, there is a small chance that this will cause bleeding, infections, injury to the colon, bladder, or a blood vessel.

o Mental health risks:

· Egg preservation may give women hope for a future pregnancy, while there is no assurance of success. If she uses the frozen eggs to get pregnant, the chance of miscarriage would mostly rely on age at the time the eggs were frozen. Because their eggs are older, elderly women miscarry more often.

It has not been discovered that egg freezing increases the likelihood of birth defects in the offspring who are born as a result. To ascertain whether freezing eggs is safe, more research is necessary.⁴

How she prepares:-

If the lady is considering freezing her eggs, look for a local fertility centre with experience. Specialists are referred to as reproductive endocrinologists.

The Centres for Disease Control and Prevention and the Society for Assisted Reproductive Technology both provide information online about pregnancy and live birth rates in American fertility clinics, despite the lack of statistics on pregnancies utilising frozen eggs. Although a clinic's success rate depends on a number of factors, including the ages of the women it treats, keep in mind that this is not always the case.

If the price of egg freezing scares her, figure exactly the amount each phase will cost and how much storage will cost each year.

Before beginning the egg-freezing process, she'll likely have a few preliminary blood tests, such the ones listed below:

1. Testing for ovarian reserve: On the 3rd day of her monthly period, her doctor might order a blood test to check the levels of estradiol and follicle-stimulating hormone to determine how many and what kind of eggs she has. The outcomes will help predict how her ovaries will respond to reproductive medications.

2. Additional blood testing and an ovarian ultrasound may be performed to get a more complete picture of ovarian function.

3. Testing for contagious diseases: She'll get tested for ailments including HIV and the hepatitis B and C viruses.⁵

What to look for:

The egg freezing procedure includes the phases of stimulation of the ovaries, obtaining the eggs, and storage.

Her ovaries will be stimulated by the synthetic hormones she would swallow to produce several eggs rather than the single egg that typically develops monthly. Medication that might be required includes:

1. Drugs for ovarian stimulation: She may inject menotropins or follitropin alfa or beta (Follistim AQ, Gonal-f) intravenously (Menopur) during an ovarian stimulation procedure.

2. Leuproline acetate (Lupron Depot), an injectable agonist of gonadotropin-releasing hormone, or cetrorelix, an injectable antagonist of gonadotropin-releasing hormone, may be suggested by her doctor (Cetrotide) as treatments to avoid early ovulation.

· Her doctor will keep an eye on her treatment. She will have blood testing to determine how she is responding to the ovarian-stimulation medications. Oestrogen levels rise as follicles expand, but progesterone levels often remain low until after ovulation.

· At follow-up appointments, vaginal ultrasonography, a procedure that uses sound waves to produce an image of the inside of her ovaries, will also be carried out to monitor the development of the fluid-filled sacs where eggs mature (follicles).

· When the follicles are prepared for egg retrieval, which is normally after 10 to 14 days, an injection of human chorionic gonadotropin (Pregnyl, Ovidrel) or another medication can help the eggs mature.⁶

The eggs restoration:-

Egg recovery is typically performed under anaesthetic in a clinic or a patient's doctor's office. In order to find the follicles, a common technique called transvaginal ultrasound aspiration involves putting an ultrasound probe into the woman's vagina.

A needle is then inserted into the vagina to reach a follicle. A suction tool attached to the needle is used to remove the egg from the follicle. There is a larger chance of conception with more eggs collected—up to 15 every cycle, according to studies.

She can get cramps after removing the egg. Her ovaries are still enlarged, so she may feel full or under pressure for a few weeks.⁷

Freezing:

Her unfertilized eggs are swiftly removed and cooled to below-freezing temperatures in order to store them for later use. The characteristics of an unfertilized egg makes it significantly more difficult to freeze and produce a safe pregnancy than a fertilised egg (embryo). The vitrification method is the most widely used technique for freezing eggs. High concentrations of chemicals known as cryoprotectants are paired with rapid cooling to help prevent the production of ice crystals during the freezing process.⁷

Observing the process:

Usually, a week after the egg retrieval, she can resume her regular schedule. Avoid unprotected sexual contact to prevent an undesired pregnancy.

If she has: she should consult her doctor:-

· A temperature of at least 101.5 F (38.6 C)

· Heavy vaginal bleeding that fills more than two pads every hour

· severe abdomen pain

· weight gain of more than 2 pounds (0.9 kilogram’s) in 24 hours

· difficulty peeing⁸

Outcomes:-

When she is ready to use them, her frozen eggs will be defrosted, fertilized with sperm in a lab, and implanted in her uterus or the uterus of a gestational carrier.

Her medical staff might advise using the ICSI method of fertilization (intracytoplasmic sperm injection). During ICSI, one healthy sperm is immediately inserted into each mature egg.

Her chances of becoming pregnant after implantation vary from 30 to 60% depending on her age at the time of egg freezing. As a woman gets older at the time of egg freezing, her chances of having a live birth in the future go down.

As a final observation:

Given the controversial nature of egg freezing, the conflicting opinions, and the information that is available from a variety of sources, family practitioners have a unique opportunity to assist women in obtaining accurate and unbiased information about their reproductive health. No of a woman's sexual orientation, age, disability, health, marital status, or socioeconomic standing, she should receive this information if she asks for social egg freezing. Family physicians should discuss this practice in the broader context of reproductive health and family planning to assist women in making informed decisions.⁹

Important issues:

· A tiny but growing percentage of women choose to freeze their eggs in order to preserve their future fertility when they anticipate a natural decline in fertility as they age.

· Egg freezing has benefits, but there is little information on how it impacts live births, and there are hazards associated with both in vitro fertilization and conception later in life.

· Family doctors should be prepared to provide women with accurate and balanced information on the safety and success rate of egg freezing, as well as similar information about alternative family-planning alternatives. Doctors should discuss the financial and ethical aspects with women who are thinking about freezing their eggs.¹⁰

CONCLUSION:

Therefore, as women age, the proportion of their total egg count that is genetically normal declines. (This problem is referred to as egg quality.) However, if a woman freezes her eggs when she is still young, they will prevent the deterioration that occurs with age and are more likely to result in a healthy pregnancy.

REFERENCES:

1. Pai, H. D., Baid, R., Palshetkar, N. P., Pai, A., Pai, R. D., Palshetkar, R. (2021). Oocyte cryopreservation-current scenario and future perspectives: A narrative review. Journal of Human Reproductive Sciences, 14(4), 340.

2. Human Fertilization and Embryology (2023). Retrieved at: -https://www.hfea.gov.uk/treatments/fertility-preservation/egg-freezing/

3. Cleveland Clinic (2023). Retrieved at: - https://my.clevelandclinic.org/health/diseases/16083-infertility

4. Mathur RS, Akande AV, Keay SD, Hunt LP, Jenkins JM. Distinction between early and late ovarian hyperstimulation syndrome. Fertil Steril. 2000;73:901–7.

5. Roberts, J., Ronn, R., Tallon, N., & Holzer, H. (2015). Fertility preservation in reproductive-age women facing gonadotoxic treatments. Current oncology, 22(4), 294-304.

6. Medical news today(2023). Retrieved at:- https://www.medicalnewstoday.com/articles/314815

7. Mayo clinic (2023). Retrieved at: - https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716

8. Wennberg, A. L. (2020). Social freezing of oocytes: a means to take control of your fertility. Upsala Journal of Medical Sciences. 125(2), 95-98.

9. Cnyfertility (2023). Retrieved at :- https://www.cnyfertility.com/ivf-egg-retrieval/

10. Chronopoulou, E., Raperport, C., Sfakianakis, A., Srivastava, G., & Homburg, R. (2021). Elective oocyte cryopreservation for age-related fertility decline. Journal of Assisted Reproduction and Genetics. 38, 1177-1186.

Received on 09.08.2023 Modified on 19.08.2023

A and V Pub Int. J. of Nursing and Medical Res. 2023; 2(3):103-106.

DOI: 10.52711/ijnmr.2023.25