Ovule cryopreservation - a method of extending reproductive youth
Every year the methods of reproductive technologies are becoming more perfect and fantastic. One of such innovations was the cryopreservation of oocytes (that is, female eggs) - the technique of preserving biological material for many years.
An important feature of cryopreservation is its ability to preserve not only the eggs, but also the seminal fluid of men, as well as embryos obtained by artificial insemination.
Why freeze oocytes
To date, anyone can “freeze” their germ cells, who are able to pay for the expensive process of removing biological material, its freezing and storage. The only contraindication is age. Ovules are frozen in women no older than 41 years.
However, there may be exceptions to this rule. For example, according to the site kp.ru, Alla Pugacheva decided on cryopreservation of eggs in 52 years. And after 11 years, the surrogate mother carried out their children in common with Maxim Galkin - a boy and a girl.
The idea of freezing eggs came from IVF. The fact is that the success of in vitro fertilization depends largely on the quantity of quality eggs obtained. And their growth and development provides enhanced hormone therapy. With the right course of events, up to 20 full-fledged oocytes are “mined” in one course, but no more than three can be inserted into the uterine cavity. An obvious question arose: what to do with the rest?
Scientists managed to create a unique technology that allows you to maintain healthy eggs for many years, and then use them for their intended purpose: to fertilize and plant embryos in the female uterus.
Due to such possibilities, cryopreservation of oocytes has already gone beyond in vitro fertilization. Perfectly healthy women who want to become mothers in a few years can also take advantage of it. But rightly they fear that with age their fertility will become lower and they will not succeed in getting pregnant.
In some foreign companies, in order to attract young highly qualified women to their jobs, they promise to provide them with free cryo-freezing. And they quietly make a career without worrying about future motherhood.
Let us list which women may need cryopreservation of oocytes or embryos:
- With an unstable financial situation: lack of work, training, change of a field of activity,
- Girls over 30, who have not yet met a man suitable for the role of the father of a child,
- Patients with medical indications associated with severe pathologies: oncology, endometriosis, cervical stenosis and others. Since the treatment of these ailments is always associated with the use of strong medical drugs and serious procedures, a woman can insure by freezing healthy and full-fledged cells,
- Women whose professional activities are connected with damage to health: over time, it provokes numerous pathologies,
- Patients with genetic disorders in the body: having received the maximum possible number of eggs, genetics can choose from them only healthy and complete ones for replanting,
- Having poor oocyte quality. It is believed that "thawed" eggs are much more viable,
- Which have medical indications for removal of the ovaries or uterus. After removal of the ovaries, replanting of the “native” embryo is possible only after preliminary freezing of the oocytes. After removal of the uterus, you can use the services of a surrogate mother.
“This procedure is recommended for women preparing for serious and long-term treatment (often anticancer) if the risk to damage the ovaries is high,” says our consultant Elena Vladimirovna Sorokina (Repromed Chelyabinsk Clinic). In principle, any woman can freeze oocytes at will. Sometimes cryopreservation is performed when an emergency IVF program is interrupted. It is needed when harvesting donor oocytes. It is possible to conceive a child using these cells at any convenient time.
A reproductive cell, frozen in liquid nitrogen, is considered fully viable after defrosting. And in some cases, this method is used specifically to improve the quality of oocytes. It is believed that "live" eggs that survived the defrost, are better implanted in the uterus than the "fresh", received a few days before replanting.
How are eggs recovered
In order to secure a successful conception in the future, a woman must “surrender” and save at least 20 oocytes. It is impossible to collect the required number of eggs during the period of natural ovulation, since one, maximum two germ cells “come out” of a woman’s ovaries every month. Therefore, doctors resort to receiving, which allows you to completely “replace” the hormonal background of the woman, creating ideal conditions for superovulation.
To achieve this goal, the patient must take hormones for 2-3 weeks, which will completely suppress the natural production of her hormones. The necessary background is created artificially in the "right" proportions, distributing the necessary hormones in a certain "dosage". Due to the stimulation of ovulation, the ovaries work in an enhanced mode, which allows you to get a lot of eggs that mature in small vesicles - follicles.
All work “carried out” by the follicles is fixed on ultrasound, because it is important for physicians not to miss the moment when the germ cells are ready to go out of their shell. If this happens, natural ovulation will occur and doctors will not be able to “collect” oocytes.
Once the follicles have reached the desired size, a minimally invasive operation is performed, which is called ovarian puncture. Using a special device, the doctor “reaches” through the vagina to the ovaries, pierces the follicles and draws the oocytes into the tube along with the fluid in which they were located. Extracted eggs are sent to the laboratory for freezing.
How to freeze oocytes
When it comes to freezing biological material, it means not just exposure to high temperatures, but a carefully developed procedure, which is carried out with the participation of high-tech equipment.
The fact is that earlier attempts were made to freeze eggs naturally, that is, slowly. However, after defrosting them, it was found that the internal structural components of the cell and its walls were destroyed because they were covered with ice crystals. Therefore, this method of preserving the oocytes was abandoned.
To date, the egg can be frozen in two ways:
- Cryo-freezing, which is carried out by replacing the water inside the cells with a cryoprotective liquid,
- Vitrification is an instantaneous transition of a biomaterial to a state of extremely low temperature conditions.
The latter method is considered the most reliable, since water in the cells does not have time to enter the crystal stage, which minimizes the risk of damage to the oocyte. The first baby from a vitrified oocyte was born in 1999.
How and how much material is stored
After the egg cell freezing is successful, it is placed in a special cone, which looks like a straw. Already in this tank, the oocyte is placed in a labeled test tube, which is immersed in a container filled with liquid nitrogen.
Numerous labeled flasks containing seminal fluid, eggs or embryos make up a cryobank, which is in every clinic that deals with reproductive technologies.
The storage time of the biomaterial depends on the wishes of the patients and their solvency, because for each day they are in a cryobank, they must be paid.
Thawing and fertilization
A woman who has used the method of cryopreservation of oocytes, pregnancy occurs only by IVF. Before being transferred to the uterus, the eggs that are in the straw are prepared for a responsible procedure: they are left to thaw at room temperature. After the thawing process, the cells are placed in a special nutrient medium. Also, immediately prior to replanting, a hetching procedure is carried out to help the unborn child break through the egg shell that has become thickened after freezing.
Read a detailed article about embryo hatching.
Chances of getting pregnant after defrosting female biomaterial a lot. We have already said that after such “weather conditions” the strongest eggs survive, therefore the fertilization success is higher than with the “usual” replanting. However, the procedure does not provide an absolute guarantee. Its result is influenced by the following factors:
- The age of the patient
- Number of embryos
- The right protocol for hormone therapy,
- The presence of individual features of the female body.
How much does cryopreservation cost?
If we are talking directly about the procedure of IVF, then the second protocol with the use of frozen biomaterial will cost the couple a little cheaper.
From a financial point of view, the procedure for freezing an egg cell for the average Russian is, although accessible, but still rather cumbersome. The total cost of the service is calculated for each patient individually, as it depends on such factors:
- The storage time of the biomaterial
- The number of stored germ cells
- Freezing method
- The presence or absence of donor material.
In Russia, in order to freeze eggs, you will have to pay from 20,000 rubles and more. "Living" frozen oocytes in a cryobank will be about 1000 rubles per month. Defrosting - about 10000-20000 rubles.
The location and rating of the clinic that conducts the procedure strongly influences the calculation of payment for freezing.
Is cryopreservation just an egg freeze?
The term "cryopreservation" really means the preservation of biological material in a viable state through very low temperatures. But this is not an ordinary freeze, but a special, carefully developed and standardized procedure. It can be carried out only with the use of specialized equipment with the function of a very rapid temperature reduction and its further maintenance at a strictly defined level. Therefore, freezing and storage of eggs is not carried out in all medical institutions, this service is provided only by well-equipped Centers of Reproduction.
Initially, when IVF was just beginning to be introduced into wide clinical practice, there was no expressed need for the preservation of germ cells. After all, highly productive schemes for stimulating hyperovulation have not yet been developed, and only 1-2 mature oocytes (eggs) were obtained from one patient in the cycle. In the subsequent there was a need for long-term preservation of germ cells without losing their viability and ability to fertilize.
At first they tried to freeze the oocytes in the usual way, slowly. But this method led to the destruction of a significant part of the cells, their cell wall and internal structures were deformed and ruptured by the resulting ice crystals. Therefore, the method of slow freezing is now recognized as insufficiently effective, it was replaced by more advanced methods of cryopreservation. Their use allows you to avoid crystallization of water and thereby significantly increase the survival of oocytes.
Currently, cryopreservation is carried out by 2 main methods:
- Cryo-freezing with preliminary replacement of intracellular water with a special cryoprotective liquid. The sex cell is slowly dehydrated in a special solution, after which it undergoes a freezing procedure.
- Vitrification - ultra-fast (almost instantaneous) cooling of the biomaterial to very low temperatures. At the same time, the intracellular water passes the crystallization stage and enters a glassy state, while the probability of damage to the structures of the oocyte and its genetic material is small.
Vitrification is recognized as the most effective method for preserving the maximum number of viable oocytes. The main contribution to its development was made by the Japanese embryologist Professor Masashige Kuvayama. Cryopreservation according to the method developed by him is carried out on cryotopic carriers and is called by his name or by the freezing of QuitoZato. The first child after fertilization of a vitrified egg was born in 1999.
How does the oocyte freeze?
Cryopreservation of oocytes involves the preliminary receipt of mature, functionally complete and fertilizable oocytes from a woman's ovaries. To do this, produce puncture of follicles ready for ovulation, the date of the procedure is determined by the doctor according to the results of preliminary ultrasound monitoring. In most cases, the fence is preceded by a stage of hormonal stimulation of hyperovulation for the maturation of a sufficiently large number of eggs. But oocytes obtained in the natural cycle of a woman can also be cryopreserved. This is practiced if the patient has contraindications for using even gentle stimulation protocols.
The collection of eggs for freezing takes place in a sterile operating room in a medical center, usually under local anesthesia. Puncture needle gently, under the control of ultrasound is injected through the posterior fornix of the vagina alternately to each ovary. Oocytes along with follicular fluid are gently sucked into the syringe with a nutrient-protective medium, after which the procedure is considered complete.
Egg collection by puncture of ovarian follicles
The resulting germ cells are immediately transported to the embryology laboratory, where they undergo a preliminary inspection and sorting. Oocytes with obvious morphological disorders, visible defects of genetic material, signs of immaturity are discarded and disposed of. They are not allowed neither to cryopreservation, nor to use in the current IVF protocol, because it is associated with a high risk of giving birth to a child with various defects and genetic abnormalities.
Selected cells are placed in microcontainers in the form of tubes, each of which is clearly labeled. After that, they are subjected to freezing by the chosen method, to create the necessary low-temperature environment using liquid nitrogen. Eggs are stored under the same conditions, and the temperature is kept stable at -196 ° C.
When is technology applied?
Freezing of oocytes, their further storage and use are carried out only with the written informed consent of the woman. The decision on this may be made for medical and social reasons. Moreover, pregnancy after freezing eggs can occur only in the cycle of IVF or IVF + ICSI.
The most common reasons for the cryopreservation of germ cells:
- Preservation of oocytes remaining unused in the current IVF protocol. Often, as a result of stimulated hyperovulation, 10 or more mature germ cells are obtained. Of these, 4-5 are usually fertilized, and no more than 3 viable promising embryos are planted. The remaining unfertilized eggs by the decision of the woman can be cryopreserved if the appropriate technical equipment of the medical center is available. This will allow in subsequent attempts at IVF to avoid hormonal stimulation and conduct a protocol with frozen oocytes.
- Creating your own cryobank of germ cells for the further implementation of the program of delayed maternity in healthy women. Such a decision can be made by young patients if they do not plan a pregnancy in the next few years, but want to avoid further the risk of infertility or having a child with chromosomal abnormalities. Indeed, with age, the risk of various mutations of genetic material increases, and a late pregnancy that occurs independently in a 37- to 45-year-old woman is associated with an increased probability of having a child with Down syndrome and other anomalies.
- Implementation of the program oncofertility. This is the possibility of obtaining in the future genetically native offspring in patients with diagnosed oncological pathology. The chemotherapy and radiation therapy prescribed to such women adversely affects the quality of the genetic material in the egg cells and may lead to the cessation of the maturation of the follicles in the ovaries. If a woman is able to independently carry out a pregnancy, embryos from fertilized cryopreserved oocytes will be transferred to her. Otherwise, the patient may use the services of a surrogate mother.
- Participation in the voluntary donation of eggs. Join this program can only young healthy women who already have their own child.
Recently, the preservation of their own oocytes has become increasingly popular. К нему прибегают, даже если женщина и не находится в группе риска по быстрому истощению овариального резерва и не нуждается в проведении цитотоксической терапии.
До какого возраста производится забор и заморозка ооцита?
Это один из частых вопросов на приеме репродуктолога. Считается, что до 35-36 лет риск различных мутаций в наследственном материале половых клеток невелик, если только женщина не подвержена действию серьезных мутагенных факторов.
Безопасна ли криоконсервация для яйцеклеток?
One should not expect that all oocytes subjected to cryopreservation after thawing will survive and retain their full functional usefulness. This cannot be guaranteed even by an experienced, highly qualified reproductologist using the most modern equipment. According to statistics, the survival rate of oocytes after cryo-freezing using cryoprotectants is about 85%. But with the vitrification of high quality germ cells, this figure can reach 95-98%.
But does fertility suffer?
At observance of all technological aspects, the use of high-quality cryopreservatives and strict pre-selection of material, the quality of the eggs after defrosting is not significantly reduced. In addition, there is evidence that vitrified oocytes after fertilization produce more viable embryos. True, this information still requires final statistical confirmation.
On average, the fertilization capacity of thawed oocytes is 70-79%, with up to 41% of the transferred embryos safely implanted normally. This indicator is not much different from that during the IVF cycle with native (fresh) oocytes. Yes, and in natural conditions, not all eggs are fertilized safely and give a normally developing pregnancy. Therefore, it is considered that technically correctly performed cryopreservation using high-quality cryoprotectors and careful selection of oocytes does not change their properties.
The success of the protocols with frozen eggs depends on the age of the woman, the state of her endometrium, and the endocrine profile. The quality of the sperm and the combination of genes resulting from fertilization are also of great importance. And the fact of cryopreservation is not considered as a pronounced risk factor for IVF failure.
Perspectivity of technology
Scientists have not yet come to a final opinion, for how long the cryobank created by a woman remains in a stable state. In the medical literature, the use of oocytes cryopreserved more than 10 years ago has not yet been described. Most often, frozen biomaterial is used for 3–5 years. But this does not mean that it can not be stored for a longer time. Just cryopreservation of eggs is a fairly young reproductive technique, which is already successfully used throughout the world and at the same time continues to improve.
Protocols of IVF / IVF + ICSI with frozen own or donor oocytes are in high demand. They are the basis of the programs of postponed maternity and fertility preservation in women with cancer pathology, they help to reduce the pharmacological load on the body of patients during repeated cycles of IVF.
Is cryopreservation just an egg freeze?
Cryopreservation is not just a freeze. This is a very complicated system of freezing the material, which is carried out only with the help of special equipment, capable of freezing in a very fast time, and later on, at one level to maintain a low temperature for a long time.
That is why not any clinic assumes such a function of freezing eggs, but only one that has certain equipment and specially trained specialists. Usually clinics that are well equipped and well recommended in reproductionology are engaged in freezing biological material.
Initially, they began to freeze the material by gradually lowering the temperature, but this technique did not give good results. Since practice has shown that with a gradual method of freezing the cells, they are half dead. Therefore, the method was considered not effective. And scientists began to look for other options for freezing.
The method of correct freezing was developed by the Japanese embryologist Masashige Kuvayama. According to his method, the first child was born in 1999.
At this time, cryopreservation is performed using:
- Replaceable intracellular water to a special cryoprotective fluid, where the sex cell is gradually dehydrated in a special solution, as a result of which there is a complete freeze.
- Ultra-fast, where instant freezing takes place at very low temperatures, at which water does not pass through the crystallization stage and immediately goes into a vitreous state. With this technique, damage to the oocytes is very low.
How is freezing of oocytes
Initially, it is necessary to obtain it for freezing biological material. This requires a material that is ready for fertilization and which is functionally complete. To obtain material, a woman is given a special puncture on the collection of finished follicles. For this, the doctor carefully prepares the woman. If necessary, conducts stimulating therapy and monitors the maturation of follicles using ultrasound. Stimulation may not be prescribed. All this is strictly individual. As a woman may have a number of contraindications to stimulating therapy.
The puncture itself takes place in a small operating room, in a completely sterile room. In this case, a woman is given general anesthesia. A special needle is inserted through the posterior vaginal fornix, strictly under ultrasound control. The oocytes are very carefully sucked together with the follicular fluid into the syringe, where the prepared nutrient-protective medium is located. The resulting material is immediately delivered to the laboratory. It is there that the material passes inspection, processing and sorting. Those oocytes that were recognized as defective are discarded. This group of oocytes is not allowed for IVF protocols and for freezing, as this may cause the birth of a child with pathology and various vices. Selected good cells are transferred to a special container, which in appearance resembles a tube. The container is labeled and subsequently frozen.
When technology is applied
Such technology as cryopreservation is applied strictly with the written consent of the woman. The decision to conduct this procedure is determined by the doctor.
If the procedure is applied, the onset of pregnancy occurs only with the help of IVF, or IVF using the ICSI method.
There are a number of main reasons why cryopreservation is prescribed. These include:
- During the IVF procedure. Save for future use of oocytes. During the IVF procedure, stimulation of the ovaries is prescribed, with the result that during the puncture the embryologist receives more than 11 germ cells, from which then usually at least 3-6 are obtained viable embryos. Of them, no more than 2 embryos are placed in the uterine cavity of the woman, and the rest, strictly at the request of the woman, can freeze. This is what makes it possible to avoid hormonal stimulation in subsequent IVF attempts.
- To create your own bank of healthy germ cells. For example, when a woman decides to implement a program of delayed maternity. The woman is planning children, but not in the near future.
- Due to the risk of further purchase of infertility or any other pathology. She decides to freeze her biological material at reproductive age. In order to further avoid having a child with various pathologies or defects.
- Also in the case of such a program as oncofertility. The procedure for freezing your own material helps a woman with an oncologic diagnosis to later obtain native genetic offspring. A woman with cancer is prescribed either chemotherapy or radiation therapy, which has a very negative effect on the eggs. This is what makes it impossible to give birth to a healthy child in the future. And the cryopreservation procedure helps a woman after her recovery give birth to a healthy baby. If, according to the testimony, she cannot independently carry out the child, then she can resort to the surrogate motherhood procedure.
- A woman can absolutely voluntarily become a donor of her biological material.
The procedure for cryopreservation is quite common and is in great demand in Russia.
Types of cryopreservation
Currently, clinics use various methods of freezing:
- freezing the biological fluid of a man - sperm,
- freezing eggs (oocytes),
- freezing healthy embryos,
- freezing of ovarian tissue.
As we wrote earlier, during the IVF procedure, no more than 2 embryos are usually placed in the uterine cavity. The rest is strictly according to the consent of the woman (or a married couple) is subjected to freezing. In the future, frozen embryos can be used for repeated IVF protocol, as well as for donation and other purposes. Frozen embryos can be stored for years. At the same time, the properties of embryos do not deteriorate. The embryos themselves are frozen in several ways:
- by quick freezing,
- by gradual freezing - slow.
Of course, as the statistics show, after freezing, the chances of getting pregnant are less than after the natural IVF protocol. But they are. And, as practice shows, children after the IVF procedure by cryopreservation are born healthier, and the pregnancy itself proceeds more safely. Children born after cryopreservation are no different from children born naturally.
One of the complicated freezing procedures. This type of cryopreservation requires careful preparation. This requires a long stage of hormone therapy. As with the natural cycle, only one egg matures. And when stimulating the ovaries, several eggs mature. When they are ready (matured), a puncture is prescribed at which the most viable are selected. Oocytes are carefully processed. They remove excess fluid. In order that then during freezing the liquid does not turn into crystals. After that, the material is placed in a special container and frozen in liquid nitrogen. This procedure is usually prescribed:
- oncologically ill women
- for surrogate motherhood,
- to keep healthy stuff
- by medical records.
How is the procedure?
After fertilization, the most enduring and high-quality embryos are selected. They are carefully treated with a cryoprotectant, which is able to protect the embryo from damage. Then they are subjected to freezing in a specially plastic straw.
Each such tube is marked. In such a capacity is placed no more than 5 embryos. Frozen embryos can be stored from one month to several decades.
Laboratory of Cryopreservation of Ovules
Embryo transfer and replanting after cryopreservation
The tube with frozen embryos is removed and thawed at room temperature. Free from cryoprotectant and placed in a specially prepared nutrient medium. Transplantation into the uterine cavity is usually performed on the same day. A woman transplant occurs in a natural cycle. Also according to the indications can be assigned to the hormonal cycle before replanting. Both methods are absolutely equivalent and the chances of getting pregnant are equal, both with the natural cycle and with additional hormonal stimulation.
The result of the transfer of thawed embryos is affected by:
- woman's age
- number of embryos planted
- the correctness of drug therapy,
- the number of previous miscarriages,
- previous pregnancy
Embryo transfer and replanting
How are eggs frozen and are there any risks?
The process of cryopreservation of eggs represents their temporary freezing and subsequent storage in honey / jar for further use in fertilization.
- One of the methods - slow freezing - today is practically not used due to the high risk of cell damage (note - crystallization of water leads to the destruction of the structure of the egg and, thereby, to reduce its viability).
- Second method - technology, called "vitrification". This method allows you to freeze the egg in the shortest possible time - instantly, with a very rapid decrease in temperature. The transition of the liquid to the glassy state occurs, bypassing the crystallization stage. That, in turn, ensures the integrity of the biomaterial (and, of course, the functions of the cell) with further defrosting.
According to studies, pregnancies after IVF with the use of thawed eggs become more successful, in comparison with the “fresh” protocols - they are not burdened by early birth or the birth of babies with low weight. That is, eggs after cryopreservation are more viable.
- First - the advice of a specialist. At this stage, it is necessary to find out - what are the true needs of a woman, what are the reasons for the appeal (just a personal desire or serious testimony), to analyze her health. Also solved all the "formalities" - payment, contract, etc.
- Next - stimulation of uterine appendages for their active production of the necessary eggs . As a rule, this is done with the help of hormonal drugs and certain vitamin therapy.
Blood tests and doctor control over the condition and function of the ovaries. The next stage is in the operating room. Here healthy eggs will be extracted using specials / needles, which the specialist puts on the suction apparatus. What is used as a painkiller? Full, but short-term anesthesia, or local anesthesia, which acts exclusively on the cervix.
Then the extracted eggs are transferred to the honey / bank for storage.
- The life of the egg. It depends on the specific abilities of the biomaterial to survive at all stages of the procedure - immediately at the moment of freezing and after its defrosting. Typically, eggs are stored for about 5 years, although it is possible to extend the contract if desired and the viability of the eggs.
- Are honey / indications required? Not. Today it is no longer necessary - the desire, the maturity of the age and the ability to pay for the procedure itself and further storage are sufficient. Age restrictions in the absence of honey / indications (optional) - 30-41 g.
- Will one procedure be enough? In the honey / bank for future success there should be at least 20 healthy and viable eggs. 3-5 eggs in the bank - this, of course, is not enough, because not all of them will remain viable after storage and defrosting. Therefore, it is difficult to speak about the number of procedures. They will need so much to provide the right number of eggs - and 4 or more procedures. Although sometimes, it is worth noting, and out of only 2 frozen eggs, one “shoots” and gives the future mother her lucky chance.
Of course, such a young technology has not only advantages, but also disadvantages. Note the most important.
Of the benefits are the following:
- The most viable eggs appear at the age of 25-30 years. By maintaining their vitality through vitrification, you increase the chances of IVF success in the future.
- Freezing helps preserve cell quality and give birth to a healthy baby with a minimum of risks regarding the manifestation of various pathologies associated with the risk of the appearance of age-related genetic disorders after 30 years.
- Cryopreservation solves problems those women that postpone the birth of babies on a "later" for various reasons.
- Also, the procedure is often used when complex treatment of infertility.
- Freezing can not be carried out with IVF re-stimulation of the ovaries.
- Freezing is not a guarantee a successful pregnancy for women who have stepped over a certain age limit. It should be understood that the preserved viability of the eggs does not cancel the "deterioration" of the organism. Namely - the deterioration of general health and blood circulation due to age, disruption of the ovaries, reducing the elasticity of the muscles of the uterus, etc. What naturally affects the course of pregnancy.
- Stimulation of the production of eggs is not so harmlessas it may seem. Of the possible consequences - disruption of the ovaries, hyperstimulation.
- The ability to “postpone pregnancy” often forms confidence in the mind of a woman that she will “have time for everything” as she wishes. But, There are both life circumstances and physical (body deterioration) that can disrupt your plans.
- Not all saved eggs will survive after defrosting. That is, the fewer of them - the less chance.
- 2 to 4 weeks hormone injections,
- taking birth control pills to stop normal hormone production,
- for 2 weeks, doctors give special injections to stimulate the ovaries and mature eggs,
- after that, the eggs are removed from the body,
- they are frozen and stored for a long time.
- some eggs weaken during defrosting,
- some eggs do not form viable embryos,
- some embryos simply do not survive.
- slow dehydration of the egg, when by progressive replacement of the transudate (intracellular fluid) to the freezing substance (cryoprotectant, consisting of mono- or polysaccharides),
- vitrification: is carried out through a single and very rapid exposure to ultra-low temperatures on the cells. Usually produced using nitrogen or its vapors.
The first method allows you to save the female sex cells, but its implementation is very high risk of liquid crystallization, and therefore - damage to the membranes (their rupture) and the death of eggs. With instant freezing, biomaterials are preserved without flaw and saved much longer. The percentage of viable (not damaged) slowly dehydrated cells is 45-50, and the rapidly vitrified cells are 98-99.
Indications for the procedure
Biological and medical:
- endometriosis, cervical stenosis, adhesions in the fallopian tubes or degeneration (cysts, polyposis, oncology), ovarian diseases with progressive destruction;
- the desire to become pregnant after a course of chemotherapy or radiation therapy (cells are taken for storage before) and also long-term treatment of chronic, hereditary or autoimmune diseases,
- the risk of early menopause, premature aging of the body,
- implementation of the procedure of eco or surrogate motherhood,
- hormonal diseases in which reproductive processes are reduced,
- for fertilization with donor sperm,
- genetic diseases in which some eggs are produced inferior (immature), here the method allows you to select healthy and mature for IVF,
- anatomical features of the genital organs (infantilism, obstruction of pipes, etc.).
Social and personal:
- postponed maternity, preservation of the opportunity to have a child of your own at a mature age (to achieve social and family well-being),
- preservation of fertility until old age,
- the lack of a decent candidate for the role of the father
- dangerous professional activities with the risk of deterioration in health.
In Russia, these cryopreservation procedures are regulated in the following legal acts:
- Order No. 107n of the Ministry of Health of the Russian Federation “On the procedure for the use of assisted reproductive technologies, contraindications and restrictions on their use” (dated August 30, 2012)
- agreement of the parties (client and cryostorage).
These documents set out:
- the right to receive such a service
- the order of its provision,
- cryopreservation sequence
- method of preserving frozen materials,
- requirements for institutions carrying out such activities,
- Biomaterial storage time and cost of the procedure.
Stages and progress of the freezing procedure
- Examination by a doctor and passing an additional examination: general and biochemical analysis of blood, ultrasound of the reproductive organs, tests for the level of female hormones, etc.
- Receiving follicles:
- hormonal stimulation to maximize their production,
- Eggs are collected from the patient by using a syringe with a special needle, under local or general anesthesia and accompanied by ultrasound.
- Cryopreservation of oocytes.
- Recovery and rest of the woman after a puncture in a horizontal position for at least an hour.
- Place the cells in a plastic container and a Dewar tube with liquid nitrogen and transport to a cryobank, where they will be stored for a long time (from several weeks to decades).
- Obtaining a certificate (contract) certifying the right to possession and disposal of biomaterials.
- Method, that is, they will use a cryoprotectant or vitrify the cells.
- The number of oocytes, the implementation of freezing eggs in units or tens.
- Storage time (how many cells will be in the cryobank).
- Qualifications of specialists conducting the procedure and counseling women.
In practice, reproduction centers usually voice the price for the storage of 3-4 eggs per month. Verification method is more expensive than slow dehydration, it is considered more reliable and effective. On average, biopsy sampling and freezing of eggs can cost their owners 15-30 thousand rubles, and storage of 1500-3000 thousand rubles per month.
Initially, cryometry of oocyte freezing could be carried out at the Moscow Perinatal Medical Center, the Metropolitan Center for Obstetrics, Gynecology and Perinatology, and the European Medical Center. Today, cryopreservation and egg conservation services are provided by advanced reproduction clinics in all regional cities of the Russian Federation.
Positive and negative aspects of cryogenic oocytes
- aesthetic side: storing your own eggs from a moral point of view looks better than a bank of embryos (their death can be acutely perceived by customers),
- selection and preservation of the best (viable) cells, with the prospect of their successful fertilization in the future,
- the opportunity to have a healthy child in adulthood
- reducing the number of ovarian punctures for IVF technology,
- donation for infertile couples,
- the ability to store their cells for years and use eggs after cryopreservation at the right time.
- death of a part of oocytes,
- pregnancy is guaranteed only for 10-15%,
- the method is not cheap and requires investment
- women have complications after ovarian stimulation (hormonal disruptions, exacerbation of chronic diseases).
However, in spite of the existing risks, hazards and financial costs, the feedback from women who have undergone the procedure of freezing their own eggs and the subsequent successful artificial insemination with them is positive. This is not surprising, because, as a rule, cryomethod is for them the last chance to get pregnant and have a full-fledged family.
Some interesting facts about cryopreservation
- The procedure is popular among women 25-36 years.
- Medicine has known a case of oocyte freezing in 47 women, with successful fertilization and implantation a year after storage.
- To distribute the method, some centers that carry out commercial companies of a different profile pay for the procedure for their employees.
- Storing eggs in liquid nitrogen requires special security measures and strict adherence to legal regulations.
- Существует теория и практические исследования о том, что потенциал яйцеклеток (их жизнеспособность), после криоконсервации и последующей разморозки возрастает, что увеличивает возможность успешного оплодотворения и проведения ЭКО.
- В ходе хранения осуществляется мониторинг состояния ооцитов.
- The maximum shelf life of the eggs is usually up to about 5 years, but some patients have kept them longer (up to 10-15 years).
- Medical indications are not priorities for the implementation of the method, the main thing is the desire of women.
- Depending on the state of the female germ cells, several punctures may be necessary for successful cryogenic freezing to collect biomaterials, but often one is enough.
Cryopreservation as a way to freeze time
What is cryopreservation and why is it needed? The essence of the technology lies in the deep freezing of cells and tissues in liquid nitrogen at a temperature of -196 ° C with the possibility of subsequent defrosting and use. All biological processes in the cells stop, the life cycle stops, and this allows the material to be stored for a long time until it is in demand.
Freezing can be carried out in two ways: the first is the slow dehydration of the cell, that is, the gradual removal of fluid from it with replacement by a cryoprotector. The second method, called vitrification, is practically instantaneous freezing without a crystallization process. Each of these methods finds its use depending on the biological characteristics of the tissue or cell.
In medicine, cryopreservation is most often used during an in vitro fertilization procedure (IVF) in order to preserve excess embryos for subsequent replanting. In addition, the method is used for a number of indications to preserve fertile sperm or eggs.
The main task of cryopreservation in reproduction is to increase the chances of pregnancy in women who for one reason or another cannot become pregnant in the traditional way. Modern reproduction science suggests using cryopreservation not only for medical, but also for social reasons. Many modern women under 40 are not ready to have children, preferring to first provide the material basis for the unborn child. However, they forget that the female body after 30 years reduces the ability to reproduce. Cryopreservation of fertile eggs at the peak of childbearing age (from 18 to 28 years) will allow a woman to later carry out her own child with virtually no risk of miscarriage. At the same time, the procedure of seizure and freezing of cells becomes more accessible both in price and in the number of clinics in which it is conducted.
On a note
The procedure of cryopreservation is regulated by the order of the Ministry of Health of the Russian Federation of August 30, 2012 No. 107n “On the procedure for using assisted reproductive technologies, contraindications and restrictions to their use” (hereinafter - Order No. 107n). It details who is entitled to receive medical care using assisted reproductive technologies (ART), what are the stages of care and the procedure for applying ART. Articles 40–53 of Order No. 107n directly regulate the process of cryopreservation, including tissue collection and storage.
Sperm cryoconservation is performed in almost any reproductive center. The indications for this procedure can be the following factors:
- Participation in the IVF program, when the sperm of the husband or donor is necessary for fertilization of the eggs before replanting.
- In case of oligospermia (insufficient sperm count) and asthenozoospermia (their low mobility). In this case, the sperm surrenders several times intermittently and frozen to accumulate the necessary amount of active spermatozoa.
- Upcoming cancer treatment, including chemotherapy and radiotherapy. Studies show that these types of treatment dramatically reduce the production of spermatozoa and their quality. In 20% of men after taking chemotherapy, temporary or even persistent infertility occurs.
- Professional sports or traumatic activities. They can damage the testicles and, as a result, sterility.
- Surgery on the male genital organs, such as a vasectomy, significantly reducing the quantity and quality of sperm produced.
- Damage to the spinal cord, as in this case, the ability to ejaculate is reduced in 95% of patients.
Cryopreservation of sperm is a reliable protection against the transfer of various diseases in their undeveloped stage.
Freezing of sperm includes examination, preparation and cryopreservation itself:
- The survey list includes:
- smear on infection
- HIV, syphilis and viral hepatitis tests
- test for the ability to fertilize and for the presence of antibodies to the herpes virus.
- Material preparation:
- placing the sample in an incubator to thin for 30–35 minutes,
- centrifuging to obtain a motile sperm fraction,
- washing and incubation with cryoprotectant at room temperature for 10 minutes,
- placing the prepared sperm into tubules and sealing.
- Material freezing:
- cooling to 4 ° С in a special installation,
- freezing for 2 hours in liquid nitrogen,
- placing the tubes in a Dewar for storage.
Frozen sperm can be stored for a long time, but the exact period of preservation of the viability of sperm is not yet clear. The longest term of cryopreservation of sperm, the use of which during fertilization has led to a healthy pregnancy, is now 21 years old.
Terms of storage of biomaterial in frozen form
The organization of the cryostorage or cryobank must meet certain requirements, since liquid nitrogen is used during storage of the biomaterial. These requirements are regulated by the Technical Standards 002 099 64.01-2006 “Rules for the design of production of air separation products”:
- A separate room in the capital building is allocated for the installation of cryo-storages.
- The floor space should provide unimpeded maintenance of each of the vaults. Between them there should be passages suitable for loading or unloading materials, as well as transporting Dewar transport vessels.
- Floor coverings must withstand the total weight of the equipment and the active load of the working personnel of the room.
- The floor should be covered with solid non-porous and non-dust-forming materials. These materials must withstand temperature extremes of up to 200 ° C.
- Indoor accommodation is prohibited placement of permanent employees and the presence of foreign equipment.
- Indoor exhaust ventilation must be provided. Installation of dust filters and humidity control systems is desirable.
- The presence of water-containing equipment, as well as water taps and pipes.
- All signaling sensors must be moved to personnel locations.
Storage conditions. In a cryobank, all biological materials are stored in special containers, pre-packaged in tubes or tubes. This storage method allows you to defrost the tubes one by one, using only the required amount of material. All tubes are labeled with patient data and placed in liquid nitrogen, where they are stored for the required time at constant low temperatures.
Organizations entitled to provide such services. In accordance with Article 41 of Order No. 107n, medical organizations providing specialized, including high-tech, medical care are entitled to provide cryopreservation and storage of embryos and germ cells. They must be equipped with cryostorage and have a license to carry out medical activities involving the provision of services of this type. The availability of a license is prescribed by the Decree of the Government of the Russian Federation No. 292 dated April 16, 2012 “On the licensing of medical activities”.
The choice of a cryobank usually depends on the choice of the reproduction clinic in which the procedure is to be carried out. Almost all medical centers of this profile are equipped with their own storage facilities.
Where can I freeze an egg in Russia - the price issue
The first baby, who emerged from a frozen egg, was born in 2010. Given the increased demand for the procedure, today it is possible to freeze eggs both abroad and in our country.
The main thing is to remember that only clinics that have the appropriate license from the Ministry of Health are entitled to carry out such procedures. The very first Russian medical centers that have mastered this technology are the Perinatal Medical Center, the Moscow Center for Obstetrics, Gynecology and Perinatology, and the European Medical Center.
Также данную услугу оказывают в большинстве клиник репродукционной медицины практически во всех крупных городах страны.
Во что обойдется женщине заморозка яйцеклетки?
В нашей стране средние цены на эту процедуру сегодня следующие:
История из жизни: ранняя менопауза в 30 лет
Дебора Андерсон-Байалис всегда гордилась своей активной жизненной позицией. At the age of 26, a San Francisco resident received a law degree, founded a technology company, and got married. In addition, Deborah decided to freeze the egg. Just waiting for her to get pregnant was not her style.
Anderson Bayalis underwent a course of cryopreservation of eggs, which cost her family $ 20,000 (taking hormones to stimulate the production of eggs, and a surgical procedure to extract from the body). Subsequently, the pair learned that the eggs needed for freezing did not grow. Doctors told her that the body is in a state of early menopause.
Deborah and her spouse were extremely dissatisfied with the results of cryopreservation. “We were just in shock. So we were striving for perfection ... It was necessary to take urgent measures,” said 30-year-old Anderson-Baylis. The search for another clinic took longer than expected. The pair underwent 3 types of treatment, success was small. , the woman tried to get pregnant herself. "We thought it would be easier," she confesses.
How does cryopreservation of eggs occur?
Many women and couples who do not want to plan a pregnancy in the near future are surprised by the realities of cryopreservation of eggs.
The process of cryopreservation of eggs usually includes the following steps:
Healthy women aged 38 years and younger produce 10 to 20 eggs per year, which gives them a good opportunity to have 1 or 2 children in the future, according to the USC fertility organization. If a woman is 38 years old, she wants more than two children or has a low ovarian reserve - the ability of the ovaries to produce eggs that are suitable for freezing is low, then she will have to go through several stages of treatment. “It's not as simple as many think,” says Jake Anderson, Deborah’s husband.
Cryopreservation or freezing of eggs is becoming an increasingly accessible procedure, as some employers cover part of the costs. Everyone needs to be aware of the intricacies of the process, says Dr. Samantha Pfeiffer, assistant professor of clinical obstetrics, gynecology and clinical reproductive medicine at Weill Cornell Medical College.
So, before making cryopreservation of eggs, make sure you can answer these 10 questions:
1. Why do I freeze eggs?
There are many reasons to freeze eggs. Someone decided to start a career first, and then plan a child. Someone wants to preserve fertility before starting a serious treatment. The most important thing is that the decision to undergo cryopreservation of eggs is conscious, says Pfeiffer, chairman of the committee at the American Society for Reproductive Medicine. You do not need to freeze the eggs just because the employer can pay for it, or because her friends do it, or you are afraid that this is the only way out. “Nothing and no one should put pressure on making such an important decision,” says Dr. Joseph O'Brien Doyle, an infertility specialist, endocrinologist working in the field of reproductive medicine at Shady Grove Fertility's Rockville, Maryland, USA.
2. Is this the right solution for me?
A clear definition of the reason why you want to freeze eggs can help you make the right decision later on. For example, Deborah Anderson-Bayalis eventually froze embryos after treatment - fertilized eggs, not just eggs, because such a process is considered more effective for the onset of pregnancy. This type of assisted reproductive technology, like embryo freezing, is suitable for women who clearly know who they want to see as the future father of the child. Women with a low ovarian reserve may consider adopting a child or taking a donor egg. Those who want to become a mother, but are now single, can apply for donor sperm, says Dr. Doyle.
3. When to freeze eggs?
Usually around 35 years old is the most suitable for freezing eggs. But all women are different, a blood test for anti-Muller hormone evaluates ovarian function and will help make a decision. It is worth considering that taking birth control pills affects the test results.
Usually around 35 years old is the most suitable for freezing eggs.
4. Where to freeze eggs?
Deborah Anderson-Bayalis and her husband learned from their own experience what a difficult way to choose a reproductive clinic. Some institutions pump hormones and collect many eggs, others behave more cautiously, but the process is more lengthy and expensive. Some clinics use outdated methods to freeze eggs for future use. More modern hospitals practice vitrification — rapid freezing of eggs. Some doctors perform this procedure daily, others rarely. In order to make an informed decision, ask the clinic staff how many times they have frozen the eggs and how many times they have thawed them, Dr. Doyle recommends.
5. Does this clinic really suit me?
A 29-year-old girl with good ovarian function is waiting for a suitable partner to carry out the cryopreservation of eggs. A 39-year-old mother with polycystic ovary syndrome does not want to have only one child and hopes to have a second one. “These situations are fundamentally different,” says Anderson. That's why it is so important to talk with like-minded people and get feedback on reproductive clinics.
6. How many eggs do you need to freeze?
The more eggs you freeze, the higher your chances of planning a healthy pregnancy in the future. It will take a lot of money and a lot of time. On average, women undergo 1.5 cycles of treatment for cryopreservation of eggs, according to FertilityIQ. The choice of the number of eggs depends on factors such as age, number of planned children, and how many cycles you are willing to endure and pay money.
Melissa, one of Dr. Doyle's patients, announced her decision to freeze 43 eggs at 33 to give birth to two children in the future. Like many other women, she expected it to be easy, simple, and fast. It took her 5 cycles and about 10 months to realize her plans, says Doyle.
Melissa announced her decision to freeze 43 eggs at the age of 33 to give birth to two children in the future. It took 5 cycles and about 10 months to realize the intended.
7. How will I pay for freezing eggs?
One cycle of cryopreservation of eggs in the USA can cost from 5 to 20 thousand dollars. This amount does not include the purchase of medicines and the fee for storing eggs, over 1,000 dollars a year, the founders of Fertility IQ say. There are ways to reduce costs: special financial loans and discount medical programs, says graduate student Melissa. “I saved thousands of dollars with these programs,” she says.
8. Do I have enough willpower?
Jamie, a 45-year-old soldier, froze her eggs at the age of 41. She recalls how she had to leave her best friend on the 40th day of her birth early to go home. At home, it was necessary to give an injection before removing the eggs during cryopreservation of the eggs. "During the extraction of eggs in clinics there is no place for rest, time to travel out of town, no parties and spontaneous meetings," said Jamie, whose name had to be changed in the press to protect privacy. It is necessary to undergo regular ultrasound examinations (ultrasound), blood tests and at least one small surgical procedure. She usually requires one-day stay in the hospital.
9. Am I willing to endure?
When the ovaries increased 10 times during cryopreservation of the eggs, no woman will feel good. "This is definitely not an easy process for the body, and it does not fit in everyday affairs, work moments or travels,” says Anderson-Bayalis. In addition, you need to learn how to make in-home shots and give up physical activity, Doyle says. hormone therapy was given: it affected her mood.
10. Am I ready for poor results?
Even if you fulfill all the prescriptions of the doctors and take the medicine, there is always a chance that the body will not produce the required number of eggs during cryopreservation. Freezing eggs does not guarantee motherhood.
Be prepared for the following treatment results:
As Pfeifer explains, “20 eggs in the freezer are not 20 children yet.” However, Melissa says that long-term treatment affected her most favorably. She learned how to take care of her body, count money, and the family became friendlier. Even if I never use any of these eggs, I’m still glad that I agreed to this event, ”she says,“ because it changed me for the better, taught me a lot and made me stronger ”.
Experiments on freezing female germ cells began to be conducted in 1986 at medical centers in the United States of America and in Canada. In the process of developing and testing the method, scientists faced a number of difficulties, it was not so easy to save the cells, many prototypes died because the freezing techniques were imperfect. Testing and legalization of this method lasted 28 years. Canadian physicians first used it for the storage of reproductive material in 2014, and then this method was used in European countries. Russian specialists have been engaged in such developments since the beginning of the 80s, with their help in 2010 the first baby was born, conceived by fertilization with donor sperm unfrozen and implanted in the uterus egg.
The essence of the method and its types
You can freeze the selected egg in liquid nitrogen, at a temperature of -196 degrees Celsius (nitrogenous vapor at -180). So they stop the biochemical processes, and the viability is maintained. Thanks to this method of cryopreservation, you can save the desired biomaterial for a long time, and after defrosting it can be used for the procedure of artificial insemination.
There are several types of freezing:
Pricing for this procedure
There are a number of factors that directly determine how much it costs to freeze a woman's egg: