Egg Freezing Overseas - Advice and Tips for Singaporean patients

[Angelica Cheng]

Social egg freezing is currently banned in Singapore. Hence, many single women who wish to preserve their fertility travel overseas to freeze their eggs in foreign fertility clinics. Because the procedure is so expensive, it would be wise to take some precautions before deciding on egg freezing overseas. Here are some advice and tips for single Singaporean ladies considering egg freezing overseas:

(1) Don’t believe claims of high IVF success rates of 40% to 50% with frozen (vitrified) eggs.

Many foreign fertility clinics will tell you that such high success rates are published in reputable medical journals, and are achieved using the latest vitrification technology that avoids ice crystallization damage. What they don’t tell you is that such high IVF success rates are in fact based on frozen donor eggs from young healthy women (20 to 25 years of age, with low BMI and high ovarian reserves i.e. AMH levels and antral follicle counts). Egg donors are carefully selected to be the most fertile women in their age group cohorts. For example in the USA, only 5% of applicants are accepted to be egg donors. This is not reflective of older career woman freezing their eggs, who are typically aged between their mid-30’s to early-40’s, with variable BMI and much lower ovarian reserves. Hence, good results on egg freezing published in reputable medical journals are highly-skewed, because most of these studies compared fresh versus frozen (vitrified) eggs from carefully-selected, young, healthy and highly-fertile egg donors.

Beware that the IVF success rates with frozen eggs drop exponentially with increasing age, due to rising incidence of chromosomal abnormalities in the frozen eggs. As such, the IVF success rates with frozen eggs from older women are very much lower than that advertised by foreign fertility clinics, as reported by the news media:

Woman who froze 11 eggs found that none of these could produce a baby:

Cruel twist of fate for single woman who froze her eggs in her 30s to ‘free her career’

Last year, with her 45th birthday looming and no sign of Mr. Right, Brigitte Adams excitedly unfroze the 11 eggs and selected a sperm donor

nationalpost.com

There's a dark side to egg freezing that no one is talking about

Egg freezing is being sold as a way to control your future. But it's not as powerful as you might think.

www.insider.com

When freezing your eggs does not work: What women should know

Women like Angela Herrera are the faces of an often untold story in fertility treatments, when frozen eggs do not result in pregnancies.

www.goodmorningamerica.com

Woman who froze 21 eggs found that only 1 could produce a baby:

Don’t count on having kids if you freeze your eggs

When Michele Harrison turned 40, she decided to sell her New York City apartment to buy a bigger one. She could afford it after laser-focusing on her career, working late nights as a single woman, traveling constantly for ad agencies and then in marketing at ESPN. While in the process of...

www.technologyreview.com

(2) Be prepared to undergo multiple egg freezing cycles to obtain sufficient number of frozen eggs to have a reasonable chance of future pregnancy, particularly if you are an older woman with low ovarian reserves. Even that is no guarantee of having a child in the future.

Table: Estimated number of eggs and retrieval cycles necessary for 1 child at different ages

Age (years)	21-25	26-32	33-38	39-42
Estimated minimum number of eggs for a single child​	10​	15​	20​	25-30​
Estimated number of egg freezing cycles required to reach the above-quoted number	1​	2​	3-4​	4-6​

How many eggs to freeze? Best practices: How many eggs to freeze per cycle :: CHR

Learn about how many eggs to freeze per cycle. How many eggs is it best to preserve? Egg freezing as a solution for deferred motherhood.

www.centerforhumanreprod.com

(3) Choose to do egg freezing in a country where there are strict regulation and good quality-control of fertility clinics and IVF labs. It is not just about costs! This is crucial, given that there had been catastrophic failures in the low-temperature storage of frozen eggs.

It is often the case that developed countries have stricter regulation and better quality control of IVF clinics, as compared to developing countries. For example, compare Australia versus Malaysia or Thailand. In Australia, IVF labs are regularly inspected and audited by the Fertility Society of Australia (FSA) and the Reproductive Technology Accreditation Committee (RTAC) of Australia. Are IVF labs in Malaysia and Thailand subjected to similar mandatory inspections and audits?

The fact that you can read the news about frozen egg storage failures in the USA confirm that American fertility clinics and IVF labs are subject to strict regulatory oversight and good quality control. Hence, they quickly acknowledged their failures publicly, despite knowing that they will likely be sued for millions of dollars.

Can such transparency and honesty be expected of private fertility clinics and IVF labs in developing countries, where government regulation and oversight are less strict?

Egg freezing industry reeling after two major malfunctions

Egg freezing clinics come under scrutiny after two major malfunctions in different parts of the country result in possible loss of thousands of eggs, embryos.

www.nbcnews.com

Heartbreak, anxiety, lawsuits: The egg-freezing disaster a year later

The news of two tank failures in 2018 horrified thousands of women and fertility doctors around the country. What — if anything — has changed since then?

www.nbcnews.com

What fertility patients should know about egg freezing

NEW YORK — The failure of systems used to store frozen eggs and embryos at two fertility clinics in the United States has rattled people who count on such clinics to help them realise their hopes of having children.

www.todayonline.com

US$15 million awarded over eggs, embryos ruined at US fertility clinic

USUS$15M awarded over eggs, embryos ruined at fertility clinic

www.channelnewsasia.com

(4) Check your ovarian reserves and health of your ovaries before doing egg freezing overseas.

Ovarian reserves are determined by measuring your blood serum levels of AMH (Anti-Mullerian Hormone) and FSH (Follicular Stimulating Hormone), as well as antral follicle count via ultrasound. If you are diagnosed with low ovarian reserves, you will likely require more egg freezing cycles to obtain an adequate number of frozen eggs for a reasonable chance of future pregnancy (See above table). This means spending more time and money.

Polycystic Ovary Syndrome (PCOS) occurs in about 10% of women of reproductive age, and is a major cause of infertility. Although a higher number of eggs are typically recovered from PCOS versus normal patients during IVF, the eggs are often less mature and poorer in quality, which may compromise the success of egg freezing. Moreover PCOS patients are more prone to ovarian hyperstimulation syndrome (OHSS), which increases the risk of cancellation of egg freezing cycles, leading to wastage of your hard-earned money.

(5) Check the health status of your womb (uterus) before doing egg freezing, particularly the presence of uterine fibroids, which most commonly develop in women between 30 and 40 years of age.

Uterine fibroids have been reported to lower the chances of pregnancy in older women doing IVF with their frozen eggs. Hence, it is not just the number and quality of your frozen eggs, nor is it just about your age at which you freeze your eggs. The health condition of your womb at the time that you are using your frozen eggs also matters a great deal. This is one point that has largely been overlooked in social egg freezing. Perhaps, it is best to ask your doctor to check your womb for uterine fibroids before freezing your eggs.

Fibroids Derailed My Egg Freezing Journey| Eggsurance Blog

Egg freezing and using your frozen eggs never follows a linear path. Complications like fibroids can derail the path to pregnancy - it did for me.

www.eggsurance.com

(6) Undergo counseling by a certified fertility counselor to be aware of all the potential risks and limitations of egg freezing.

In developed countries such as Australia, it is mandatory for patients to undergo counseling by a certified fertility counselor, before doing the egg freezing procedure. By contrast, in Malaysia and Thailand there is no such mandatory requirement, and only the fertility doctor provides all the advice, which may be biased because the IVF clinic itself wants to promote egg freezing.

Counsellors

Our experienced social workers, counsellors, and psychologists are available before, during and after your fertility treatment, whenever need support.

www.mivf.com.au

Perhaps, it may be a good idea to consult a local fertility counselor in Singapore about egg freezing, before traveling overseas to do the procedure. Note that fertility counselors in Singapore have to be accredited by the Reproductive Technology Accreditation Committee (RTAC) of Australia.

Team (proposed new) — Counsellingconnectz

www.counsellingconnectz.com

The above text was adapted from the following online article:

Expert Talk: Social Egg Freezing Overseas For Women In Singapore

 

[Angelica Cheng]

Excellent blog detailing a Singaporean woman's experience in freezing her eggs in Kuala Lumpur, Malaysia:

Egg Freezing in Singapore - Procedure, costs, benefits, risks & side effects

Considering egg freezing? Everything about egg freezing - detailed experience, why you should freeze your eggs, costs and risks.

annahaotanto.com

 

[Angelica Cheng]

Q & A on the Quora website:

Social egg freezing - if you have frozen your eggs overseas as a single woman, can you later import into Singapore after getting married?

Answer: You had previously undergone social egg freezing overseas as a single woman because the procedure is banned in Singapore. But do you know that you can legally import your own frozen eggs for local IVF treatment after you get married? There maybe several reasons why you prefer to receive I...

www.quora.com

How do you maximize your chances of future conception and pregnancy with social egg freezing?

Angelica Cheng's answer: Here are things that you can do to maximize your chances of future conception with social egg freezing: (1) First and foremost, freeze your eggs as young as possible, preferably before the age of 35. There is medical evidence that a woman’s fertility drops sharply after ...

www.quora.com

Why is social egg freezing (non-medical reasons) for single women banned in Singapore?

1 person wants answers to this question. Be the first to answer.

www.quora.com

 

[Angelica Cheng]

Six things you should know if you are considering freezing your eggs

Six things you should know if you are considering freezing your eggs

If you are looking to freeze your eggs, here are six things to consider.

theconversation.com

 

[Angelica Cheng]

Excellent blog detailing a Singaporean woman's experience in freezing her eggs in Bangkok, Thailand:

I froze my eggs in Asia

Hi everyone,

gwendolynregina.medium.com

 

[Angelica Cheng]

Tighten rules for doctors referring women to overseas facilities for social egg freezing

The ban on social egg freezing in Singapore was recently debated in Parliament. The procedure refers to women choosing to freeze their eggs for non-medical reasons.

www.todayonline.com

Tighten rules for doctors referring women to overseas facilities for social egg freezing

The ban on social egg freezing in Singapore was recently debated in Parliament. The procedure refers to women choosing to freeze their eggs for non-medical reasons.

It was reported that there is a growing number of women here who travel abroad to freeze their eggs because it is not allowed in Singapore unless there is a medical reason.

In recent years, there have been fertility doctors in Singapore who have taken a more active role in this process, by providing medical screening services to assess ovarian reserves and giving advice and referrals for women planning to freeze their eggs overseas.

What may have been largely overlooked are the possible financial interests that fertility doctors may have in foreign medical institutions that could bias their advice to patients, in particular their recommendations of suitable foreign fertility clinics for egg freezing.

It would thus be good that the following safeguards be implemented.

First, there should be strict standardised guidelines on informing patients about the medical risks and failure rates of egg freezing.

In particular, older women should be made aware that they need to undergo multiple egg collection and freezing cycles to obtain a sufficient number of frozen eggs to have a reasonable chance of future pregnancy.

For women who freeze their eggs overseas and make that trip just once, they would be in for a very big disappointment should they fail to conceive in the future with their own eggs.

Scientific data published in reputable medical journals claim high success rates of in-vitro fertilisation (IVF) with frozen eggs, but these may be misleading to patients who lack specialised knowledge in this area.

For example, patients are often ignorant that many of such published studies were comparing frozen and fresh donated eggs of young women between 20 and 25 years of age, which were collected specifically for use by infertile patients.

This is certainly not reflective of older career women freezing their eggs, who are typically aged from mid-30s to early-40s, with lower-quality eggs.

Perhaps, the Ministry of Health should prepare a standard booklet, pamphlet or website page of relevant information for women intending to do egg freezing overseas.

Second, it must be made mandatory for fertility doctors to advise their patients against egg freezing, if certain factors are present that would drastically lower their chances of conceiving with frozen eggs.

These include being above 40 years of age, or if medical screening were to diagnose certain conditions, including exceptionally low ovarian reserves, health problems with their ovaries such as polycystic ovary syndrome or health problems with their womb such as extensive uterine fibroids, scarring or adhesions.

Third, for greater transparency, for fertility doctors recommending or referring patients to do egg freezing overseas, it should be compulsory for them to openly declare their financial interests in relevant foreign medical institutions, such as shareholding or joint proprietorship.

 

[Angelica Cheng]

Egg freezing in your 40s "not sensible"

Egg freezing in your 40s 'not sensible'

Regulator says providers should make it clear that the chances of success dwindle once a woman reaches 35.

www.bbc.com

Clinics must make it clear that there is little point in women over 40 freezing their eggs, because the odds of a future pregnancy are very slim, says UK fertility regulator the HFEA.

Fertility declines with age, so the optimum time for egg freezing is before a woman turns 35, it says.

Yet data shows that the most common age at which women are treated is 38, with many freezing eggs into their 40s.
NHS clinics usually have a younger cut-off age, but private ones may not.

Women can only get egg freezing on the NHS if it is for medical reasons, such as needing a cancer treatment which may cause them later fertility problems. Private clinics also offer it to women who want it for social reasons, like delaying starting a family because they haven't met the right partner yet. In 2016, 80% of the 1,310 freezing procedures carried out were done in private clinics.

Around 890 of all the treatments were for women aged 35 and over, compared with 419 treatments for women younger than this. The HFEA says it is not clear why patients of this age are freezing eggs. Most women freezing eggs using NHS funding were aged below 35, with 89% below 38.

It says women must be given clear information about the risks, costs and likely success rates of egg freezing, which is becoming an increasingly popular "fertility insurance" back-up plan.

Egg freezing facts

• Success rates can be low
• Egg quality and number naturally drops as a woman gets older
• It is not a simple fix for delaying motherhood
• NHS funding may be available if you are having medical treatment that affects your fertility
• Frozen eggs can usually only be stored for 10 years (although there are some exceptions for medical reasons)

Egg freezing costs anywhere between £2,720 and £3,920 per go.
Most clinics will include a couple of years of storage in that price, but there may be an extra annual charge of up to £350 for that service.

The complete cost if you then opt to thaw and use your eggs in a future treatment, is £7,000 to £8,000.

Birth rates from frozen own eggs are increasing but remain below that of conventional IVF treatment cycles, being successful one in every five times, on average, compared to around one in three for "fresh egg" IVF.

While a woman's age at thaw has relatively little impact on a woman's chances of success, the age at freeze does, with evidence suggesting that if eggs are frozen below the age of 35, the chances of success will be higher than the natural conception rate as the woman gets older, says the HFEA.

HFEA Chair Sally Cheshire said: "Clinics have an ethical responsibility to be clear that egg freezing below the age of 35 offers women their best chance of creating their much longed-for family."

Aileen Feeney from Fertility Network said women should know their fertility "vital statistics" 28:35:42: "By 28, female fertility has already begun to fall; 35, female fertility plummets; 42, your chance of becoming a biological mother is vanishingly small."

Prof Simon Fishel, from the independent IVF provider CARE Fertility Group, said women face a hard choice, knowing that if they freeze eggs early they can still only be stored for 10 years.

 

[Angelica Cheng]

Women 'need to know egg freezing risk'

Women 'need to know egg freezing risk'

The Royal College of Obstetricians and Gynaecologists warns about low success rates and high costs.

www.bbc.com

Women who freeze their eggs need to be aware of the "relatively low success rates" of becoming pregnant, a leading gynaecologist has said.

With more women freezing eggs past the age of 35, when chances of conceiving fall, Prof Adam Balen said: "Egg freezing does not guarantee a baby." However, Dr Jara Ben Nagi says freezing can help single women wait until they meet the right partner to have a baby. She said women should not be pressured into a relationship to get pregnant.
Two groups of experts have been debating the benefits and risks associated with social egg freezing and IVF treatment for women in their late 30s in BJOG: An International Journal Of Obstetrics And Gynaecology.

'Punished with childlessness'

Prof Balen, of the Royal College of Obstetricians and Gynaecologists, said: "Success rates for egg freezing have improved significantly in recent years, so offer an opportunity for women to freeze their eggs for social reasons if they're not ready to have children yet.

"While women should be supported in their choices, they must be informed about the relatively low success rates, high costs and side-effects."

"Women should also be aware that in the UK the storage limit for eggs frozen for social reasons is currently limited to 10 years."

He warned that women should speak to a reproductive specialist and choose an experienced clinic to visit, adding that the best time to freeze eggs is in a woman's early 20s and certainly under the age of 37.

However, Dr Ben Nagi, from the Centre for Reproductive and Genetic Health, and her colleagues argue that the preservation of eggs offers more time for single women to find a relationship and gives them hope at a time that their pregnancy chances may be receding.
They point out that in a study of 1,382 women who underwent social egg freezing, 120 returned to use their eggs after an average time of just over two years and that 45 of 95 women who were single at the time came back when they had a partner.
They add that the survival rate of the frozen egg using the new vitrification method was 85%, with pregnancy rates of 27% - similar to a 23% success rate for IVF in women aged 35 to 37.

They said: "Women should no longer be punished with childlessness for not finding a partner, nor should they feel pressured into a relationship because of their declining ovarian reserve."

Dr Timothy Bracewell-Milnes, from Imperial College London, and co-authors from Chelsea and Westminster Hospital in London, warn that the majority of women are taking measures to preserve their fertility too late.

They said it is being done as a "last-ditch effort" instead of a planned and informed choice in their early to mid-30s.
They said research has shown young people are not aware of the natural limits of female fertility and "significantly overestimate" the success rates of freezing eggs to get pregnant later.

"Egg freezing is indirectly encouraging women to have children at an advanced maternal age, which carries with it significantly increased risk of medical complications in pregnancy," the authors said.
For women in their late 30s, they said 30 eggs would be needed to have a good chance of getting pregnant.

This would require three cycles of ovarian stimulation which would cost around £15,000. On top of this there will be an annual storage fee of £200-400 and the cost of future fertility treatment to use the frozen eggs.

They agree egg freezing should be available to single women in their late 30s "who accept the high costs and low successes, but they must be provided with accurate and balanced information on the safety and likelihood of success".

But they do agree that women need to be made aware of all the information to make an informed choice.

 

[Angelica Cheng]

7 things every woman should know before freezing her eggs

7 things every woman should know before freezing her eggs

As women age, the likelihood of chromosomal abnormalities climbs, and with it, the risk of miscarriage, birth defects or disorders that makes conceiving more difficult. Egg freezing is seen by some as a way to stop the biological clock, expand reproductive options and preserve the younger...

www.pbs.org

As women age, the likelihood of chromosomal abnormalities climbs, and with it, the risk of miscarriage, birth defects or disorders that makes conceiving more difficult. Egg freezing is seen by some as a way to stop the biological clock, expand reproductive options and preserve the younger, possibly healthier eggs. And for many women looking to extend their childbearing years, it has has become an increasingly attractive option.

The nation turned its attention to the issue in October when Facebook and Apple announced that they would cover up to $20,000 in costs for the procedure.

But just how successful is it? How invasive? How expensive? When it comes to the details, is this something women should seriously consider? And if so, who?

We turned to experts for the answers. Here’s what they told us.

What does egg freezing mean, exactly?

The process of egg-freezing, or in medical speak, oöcyte cryopreservation, involves stimulating the ovaries with hormones to produce multiple eggs, retrieving the eggs from the ovaries and taking them to the lab, where they’re cooled to subzero temperatures to be thawed at a later date.

Why might a woman opt to freeze?

Reasons vary. Some women choose to freeze their eggs for medical reasons. Cancer treatment, for example, can be toxic to the ovaries and cause premature menopause. Dr. Nicole Noyes, director of fertility preservation at New York University School of Medicine, said she’s overseen more than 200 cycles for medical reasons, mostly cancer, with women evenly divided between lymphoma, breast and gynecologic cancers.

But it’s not all medical. About three-quarters of the women who freeze their eggs do so because they don’t have a partner, Noyes said. She is the senior author of a New York University study released in May 2013.

“The primary reason given by women we surveyed is that they are not in a relationship conducive to childbearing,” Noyes said. “The second reason is women have something they need to get done before children, whether that’s their career or school.”

Indeed, among the first wave of egg freezers — those who froze their eggs from 2005 to 2011 — more than 80 percent had no partner, said Sarah Elizabeth Richards, author of the book, “Motherhood Rescheduled: The New Frontier of Egg Freezing.”

But the “why” is shifting, Richards said. Women are increasingly deferring childbearing in order to focus on demanding careers, and the age has dropped.

“The average age at which a woman freezes her eggs is now 36,” she said, down from 38. “Now, and really starting with [the Facebook and Apple announcement], we’re seeing women freeze their eggs younger and younger, and the public narrative around it is changing. Women are doing it for work now, which is very different from the first wave of freezers.”

How invasive is the procedure, and how risky?

The process of retrieving eggs is identical to the first phase of in vitro fertilization, or IVF.

“You are going to get anesthesia and there will be a needle puncturing your vaginal wall,” said Dr. Jaime Knopman, an endocrinologist and infertility specialist with the Reproductive Medicine Associates of New York. “That has a risk for infection, but as far as surgical procedures go, it’s a low-risk one.”

The procedure goes like this: The woman receives a round of hormone injections that stimulate the ovaries to produce multiple eggs. This stage involves frequent visits to the fertility clinic, about five in 10 days, while the ovaries are regularly monitored by vaginal ultrasound. After roughly a week or two of hormone treatments, the eggs are retrieved.

“I think people picture that it’s months of shots and invasive procedures, but in the end it’s a maximum of two weeks,” Knopman said.

The egg retrieval process takes about 10 minutes and is done under mild anesthesia or sedation. Using an ultrasound, the doctor guides a needle through the vagina to the ovarian follicle containing the egg. A suction device at the end of the needle removes the eggs from the follicles.

Retrieving the eggs is technically not that different from getting blood drawn, Noyes said. A needle goes into the ovary and the eggs get gently aspirated out.

“It’s just in a different area of the body: the vagina,” she said. “That makes people eyes bulge when I say it. But it’s exactly the same as a routine IVF retrieval.”

While the surgical procedure is mostly safe, the hormone shots do carry a risk of ovarian hyperstimulation syndrome, or OHSS, which makes some women ill, said Dr. Samantha Pfeifer, chair of the American Society for Reproductive Medicine practice committee. That occurs when a woman responds too aggressively to the hormones and the ovaries become swollen and painful. It can be accompanied by nausea, vomiting and abdominal pain.

When hyperstimulated, the ovaries produce a lot of fluid, which has to be drained from the abdomen with a needle. OHSS tends to happen in younger women in their 20s and 30s, she said, and occurs in less than 5 percent of patients. But in severe cases, OHSS increases the risk of kidney failure and blood clots and in very rare instances, can be fatal.

“It can be managed,” Pfeifer said. “But you can’t always predict who will get it or 100 percent prevent it.”

Will the hormone shots make me crazy?

Not really, but they do cause moodiness and bloating. Noyes compared it to eating too much pie after Thanksgiving.

“You feel more bloated than you do after eating pie. The hormones make the ovaries swell a little bit, because they have to create space to accommodate the multiple expanding follicles, each containing a maturing egg,” Noyes said.

“It’s funny sometimes hearing how people say they feel,” Knopman said. “I’ve had patients tell me they feel amazing and awesome. I’ve had people say they feel great and others say they feel tired. In general the emotions are steady, and I don’t see patients having a crazy, emotional response.”

What are my chances of having a baby later if I freeze my eggs now?

The chance that a single frozen egg will lead to a live birth is about 2 to 12 percent, according to the American Society for Reproductive Medicine. That’s why doctors often recommend having a couple dozen eggs frozen to maximize success.

Success is based on a number of factors, from a woman’s age to the quality of her partner’s sperm, Pfeifer said. According to one study published in the journal Fertility Sterility in May 2013, a 30 year-old woman with two to six thawed eggs had a 9 to 24 percent chance of one of those eggs progressing to a live birth, depending on the method of freezing. At age 40, that number dropped to between 5 to 13 percent.

In a January 2013 report, ASRM said that egg freezing technology has “improved dramatically” and that it should no longer be considered experimental. But the study concluded that there wasn’t enough data to recommend egg freezing for the purposes of delaying childbearing. More data is needed on safety, efficacy, ethics, emotional risks and cost effectiveness.

Is a 35-year-old egg that’s been frozen really healthier than a 40-year-old egg that’s been freshly harvested?

It may be hard to believe that an egg removed from its natural state and frozen for years could more readily lead to a baby than a slightly older egg that’s remained inside your body. But Knopman insists that if you’re a woman in your early 40s, eggs that were frozen in your late 30s are your best chance of conception.

“The most important thing for eggs is time. The younger the egg, the healthier it is,” Knopman said.

Noyes agreed.

“Absolutely. Those younger eggs are healthier,” she said.

 

[Angelica Cheng]

But freezing the eggs can cause some damage. Once fertilized, the egg becomes an embryo. Doctors often follow embryo development for about five days in the incubator looking for “blastocyst” formation at the end of this time period. The blastocyst is comprised of two parts; an outer layer, known as the trophectoderm, which is destined to become the placenta and an internal cellular ball called the inner cell mass, which ultimately forms the embryo. Fewer frozen eggs make it the blastocyst stage, Noyes said. But, she added, “the eggs that do seem just as good as fresh eggs.”

But there have been no studies yet on how long eggs can be frozen and survive the thawing process, Pfeifer says. She chaired the American Society for Reproductive Medicine’s committee that declared egg freezing no longer an experimental procedure. At the time, the longest any egg had been frozen was four years, she said. In the majority of studies, the eggs were frozen for a few weeks or months. That’s something that women who don’t plan on having children for a long time need to consider, she said.

“The expectation is they should be fine, but has anyone frozen an egg for 20 years and used it? No,” she said. When to freeze is a matter of opinion; many doctors see 34 as a good age to freeze eggs, though some recommend younger, Pfeifer said.

But Noyes said her clinic recently had success with eggs frozen for seven years — a promising sign, she added.

“Women definitely feel empowered by the experience,” she said. “They come in scared of not having a baby and they leave with their eggs in the bank. They feel like they have a much higher chance of having a baby later.”

Is this an elitist thing? How much does the procedure cost?

At most centers the egg retrieval procedure costs about $10,000, and that doesn’t include the drugs, which alone can range from $3,000 to $5,000.

“Some people will have their medication covered by insurance companies and some will not, because it’s considered an elective procedure,” Knopman said.

Cold storage costs from $500 to $1,000 in annual fees. And when you’re ready to use the eggs, they must be thawed and then fertilized to prepare for the IVF process. Each round of IVF costs somewhere between $3,500 and $5,000.

“So, for now, without insurance coverage, it’s a rich person’s game,” Noyes said.

With no guarantee on how long the eggs will be viable, freezing eggs isn’t always a financially or medically sound choice, especially when women don’t know when — or if — they will want to use them. It’s better to freeze eggs when women are young and healthy, but a woman in her 20s should carefully consider the costs and risks, Pfeifer said.

Egg production starts declining after age 35, Pfeifer said, so a woman in her late 30s or 40s may need to go through the hormone treatments and collection cycles several times. And not all the eggs will be good. Among women over 40, about 15 percent of the eggs produced will be normal, Pfeifer said.

Many doctors recommend freezing about 20 eggs.

“These cycles are not cheap,” Pfeifer said. “You have to think about an individual going through this four times to store up to 20 eggs.”

And Richards pointed out that in certain markets, costs are declining, making the procedure more accessible. Some clinics now offer package deals, where they’ll lower the price if you do three or more rounds of egg retrieval.

“There are some markets offering it for as low as $4,000. When I froze my eggs it cost $13,000, so that’s a big difference,” Richards said. “And at the moment, there is some theoretical talk about parents gifting egg freezing to law school graduates. In reality, when parents know more about egg freezing, it will become more common to have that conversation.”

 

[Angelica Cheng]

8 things you should consider before freezing your eggs

8 Considerations Before Retrieving or Freezing Your Eggs | Ro

If you're considering egg freezing or egg retrieval, here are 8 important facts to keep in mind about the egg harvesting process and what to expect.

modernfertility.com

1. Egg freezing isn't an insurance policy.
Let's start with a common misconception (no pun intended): While egg freezing may take some of the stress off of you in terms of knowing your baby-having timeline right now, it's not necessarily a surefire way of guaranteeing your forever fertility.

Why? Not all the eggs you freeze are going to be viable — think quality as well as quantity in this situation. How many eggs survive the warming process and can be successfully fertilized depends on how old you were when you froze them (more on this later), and how many are healthy and viable once they come out of storage. Plus, fertility does change with age, so if you freeze your eggs at 25 and use them when you're 35, you'll have to contend with the realities of conception and pregnancy at that age.

These aren't arguments for or against freezing your eggs — only you and your doctor can decide if that's the right decision for you — but it's important to know going in that it's not a matter of freezing and forgetting.

2. There's no perfect age at which to freeze your eggs — but there are better ages.
According to the American Society for Reproductive Medicine (ASRM), an optimal time to freeze your eggs is in your 20s and early 30s, while you have a higher ovarian reserve (the number of eggs in your ovaries) and healthier eggs. Having your fertility hormones tested (with, for example, Modern Fertility!), can tell you a lot about the state of your ovarian reserve and help you decide, with the input of your doctor, if egg freezing is right for you. That said, egg freezing is not recommended for people over age 38.

➡Get a free pre-pregnancy checklist

3. The egg retrieval process (aka egg harvesting) can be intense.
There's a lot that goes into egg freezing, before you even get to the part where the eggs are actually frozen. First, you'll have blood drawn to evaluate your ovarian reserve and screen for infectious diseases. You might also have an ultrasound done to see what's up with your overall ovarian function. Then you'll take synthetic hormones that stimulate your ovaries to grow a cohort of follicles (the fluid-filled sacs that house and protect your eggs) and, at the same time, medicine to prevent you from ovulating before egg retrieval (sometimes called "egg harvesting").

After an ultrasound has confirmed your follicles are ready for egg retrieval, you'll give yourself injectable human chorionic gonadotropin (hCG) to help with egg maturation. The retrieval itself happens in a doctor's office, along with a transvaginal ultrasound aspiration (yes, you can be anesthetized for this procedure). An ultrasound probe is inserted into your vagina to locate the mature follicles. Then your doctor will insert a long, hollow needle through the vaginal canal to the ovaries, then apply suction to remove the eggs one by one.

You can remove multiple eggs at a time, which is ideal since it gives you the best chances of getting a healthy, mature egg that can be fertilized. After the eggs are retrieved (which usually takes under 30 minutes), they're flash frozen in liquid nitrogen as part of a process called vitrification. Vitrification by liquid nitrogen dramatically increases the survival rate of eggs versus older technology, which now goes by “slow freezing.” A 2009 study revealed that eggs frozen via vitrification had a 91% survival rate versus eggs that were frozen slowly (though almost no clinics use slow freezing anymore), which had a 61% survival rate.

4. There can be side effects.
Everyone's bodies are different (write this down and put it somewhere you can see it all the time), but experiencing the following symptoms after egg freezing is totally normal and will abate with time:

• Cramping and pain from the egg retrieval procedure
• Mood swings as the result of all those hormones

You might want to proactively schedule time off for the day of egg retrieval, but after the procedure, you'll likely be able to return to work and resume normal activities within a week. Avoid making any life-changing decisions immediately after retrieval (you know, other than the one you just made to freeze your eggs). As a heads up, it's also possible to get pregnant after the procedure since there could be some eggs hanging around that didn't get retrieved, so steer clear of unprotected sex with a partner who has sperm.

The following symptoms are important to watch out for because they could be indications of ovarian hyperstimulation syndrome (OHSS) — a reaction to the fertility medication that promotes ovulation:

• Weight gain
• Bloating

The likelihood that you'll get OHSS, though, is a lot lower than it used to be — thanks to the establishment of identifying risk factors (polycystic ovary syndrome, for example), measuring anti-Mullerian hormone (AMH) levels prior to using stimulation medications, and individualizing the hormone protocol that preps you for the egg retrieval procedure.

In general, more longitudinal data is needed to really know the long-term effects of the egg freezing process. Because long-term hormone replacement is linked to increased breast cancer risk, the intense amount of hormones used in order to stimulate the ovaries of young egg donors (egg donation involves the same process of egg harvesting) could potentially increase their risk of breast cancer — but the reality is that, right now, we simply don't know.

 

[Angelica Cheng]

5. Egg freezing can be a good option if you have certain health issues.
Egg freezing could be a way to preserve your current fertility if you have cancer that requires chemotherapy or radiation (both of which could affect your fertility), you need to have surgery that could damage your ovaries, or you have a condition that could do the same. Learning you have a family history of early menopause, Turner's Syndrome (a chromosomal abnormality that comes with a risk of premature ovarian failure), or a genetic mutation (like BRCA, which can predispose one to developing breast and ovarian cancer) and deciding to remove your ovaries might also be good reasons to talk to your doctor about whether or not you're a good candidate for egg freezing.

6. It's expensive (and navigating insurance can be tricky).
If you're considering egg freezing, it's good to get acquainted with the costs of the procedure and what your insurance may or may not cover. According to FertilityIQ, the cost of an egg freezing cycle is between $15,000 to $20,000, and don't forget to take into account the cost of egg storage, which can run you up to $1,200 a year depending on where you go (sometimes the first year of storage is free!). Should you decide to pull those eggs out and use them, the costs of IVF vary, but you could be looking at cumulative costs of $40,000-$60,000. Many clinics offer shared risk options and packages, as well as loans and other financing options.

Coverage for fertility treatments like egg freezing varies based on what insurance you have. 19 states do require insurance companies to supply coverage for infertility treatments, but that doesn't mean coverage is free — you're still responsible for copays if you have private insurance. You also have to qualify for coverage, and that means meeting the criteria for infertility: being unable to conceive after one year of timed, unprotected sex if you're under 35, after six months of it if you're over 35, or if you've been unable to carry a pregnancy resulting in a live birth after a year. Be vigilant in investigating details if you live in one of these states (and with insurance in general) as there are nuances in each policy.

7. Should you freeze eggs or embryos?
First, some 101: Eggs are unfertilized, and embryos are eggs that have been fertilized with sperm. Freezing your eggs offers more options — you don't have to know who's going to fertilize those eggs and you can take some time to figure that out.

Embryo freezing is useful if you have a cis male partner or donor and want to get pregnant via an embryo transfer in an IVF lab later on. It's also possible that you'll end up with more embryos than you might want to use and find yourself confronted with what to do with them: Discard? Donate? Keep them frozen? What happens to those embryos if you end your relationship with the person whose sperm was used?

The same issues apply — how many will survive freezing, how many will result in a successful pregnancy — whether you're dealing with embryos or eggs. So, ultimately, the answer as to what to do is between you, a partner (if you have one), and your care team.

8. Getting informed in advance can help.
It's easy (and understandable) to feel overwhelmed when making decisions about your fertility, not to mention about your healthcare in general. Modern Fertility can help you take concrete steps now so you can get an idea of whether or not egg freezing is something you might want to consider. For example, learning about what your AMH levels (which indicate your ovarian reserve) are at right now can help you predict ovarian stimulation — that's when you take hormone medication to generate eggs — or IVF success should you decide to freeze your eggs and use them later.

The Modern Fertility Hormone Test hooks you up with important information about up to six hormones (including AMH): what they're up to and what you might expect from them in the future (keeping in mind, of course, that there is no absolute predictor when it comes to any of this). You'll also get results and data points you can use to start a conversation with your doctor or your partner.

 

[Angelica Cheng]

US$15 million awarded over frozen eggs, embryos ruined at US fertility clinic

US$15 million awarded over eggs, embryos ruined at US fertility clinic

USUS$15M awarded over eggs, embryos ruined at fertility clinic

www.channelnewsasia.com

 

[Angelica Cheng]

Forum: Permit social egg freezing and let younger women pay using their CPF money

I strongly agree with Ms Malavika Menon that permitting social egg freezing in Singapore would expand family planning choices for young women and allow them to undergo this difficult and painful medical procedure within the comfort and security of their home environment (Dilemma of social egg...

www.straitstimes.com

It is difficult to justify direct government subsidies for egg freezing, as this is an elective procedure linked to personal responsibility for one's own actions and life choices, unlike subsidised in-vitro fertilisation treatment for infertile couples.

Instead, a three-pronged strategy can be considered.

First, younger women should be permitted to use their Central Provident Fund (CPF) money for egg freezing.

Second, the Government could consider providing low-interest loans to fund egg freezing pegged to CPF ordinary account interest rates, similar to HDB housing loans or loans for university tuition fees.

Third, younger women should be allowed to donate some of their retrieved eggs to infertile patients, in return for subsidies from these patients, which would ease the financial burden of egg freezing. Younger women, particularly those below 30, readily produce an excess number of eggs upon hormonal stimulation.

Stringent safeguards should be implemented with such financial assistance schemes, such as strict age limits, along with mandatory medical screening of reproductive health to ensure that prospective patients are good candidates for egg freezing.

Excluding older women from such financial assistance will also push and encourage women to freeze their eggs when they are much younger, thereby leading to much higher chances of future reproductive success.

 

[Angelica Cheng]

Forum: No guarantee egg freezing will produce a viable pregnancy

Ms Malavika Menon seems to favour a rethink of current policies on non-medical reasons for egg freezing (Dilemma of social egg freezing for women in Singapore, July 11).. Read more at straitstimes.com.

www.straitstimes.com

No guarantee egg freezing will produce a viable pregnancy

Ms Malavika Menon seems to favour a rethink of current policies on non-medical reasons for egg freezing (Dilemma of social egg freezing for women in Singapore, July 11).

Those in favour of social egg freezing seem to think that women should no longer be punished with childlessness for not finding a partner, and should not feel pressured into a relationship because of their declining fertility.

It is natural for women in their 20s to worry that their biological clock might run out of time.

Presenting egg freezing as an insurance against future infertility is the strategy many egg-bank companies use to sell egg freezing to women.

Freezing your eggs could buy you time and give you more choices for the future, but such aggressive marketing may be misleading.

The American Society for Reproductive Medicine estimates that even for younger women below the age of 38, the live birth rate is between 2 per cent and 12 per cent.

If a woman who froze her eggs in her early 20s waited until her late 30s to use them, there is no guarantee that those eggs would produce a viable pregnancy.

Egg banks are offering fertile women a solution for potential infertility that they may not even face.

 

[Angelica Cheng]

 

[Angelica Cheng]

 

[Angelica Cheng]

https://www.todayonline.com/commentary/assessing-whether-lift-ban-social-egg-freezing-here-are-some-issues-singapore-should

If Singapore allows social egg freezing, here are some issues that should be addressed

The Government is expected to give a response in a White Paper by the end of the year after the women’s wing and youth wing of the ruling People’s Action Party proposed lifting the current ban on social egg freezing for single women.

Part of the Government’s deliberation process will undoubtedly involve examining some of the pertinent ethical challenges and pitfalls of social egg freezing.

This matter was raised earlier in the year when there was a debate on permitting social egg freezing in Singapore to address the drastic drop in fertility rates caused by the increasing social trend of late marriages and delayed childbearing within the country.

One foreseeable problem of social egg freezing is that there will be an accumulation of excess unused and unclaimed frozen eggs in storage within fertility clinics.

Indeed, an Australian study reported that the majority of women who freeze their eggs do not eventually utilise them.

In that particular study, researchers surveyed nearly 100 women who had elected to freeze their eggs between 1999 and 2014 for the purpose of delayed childbearing.

They found that just 6 percent of the women had utilised their frozen eggs at the time of the survey, with 3 per cent having given birth using the frozen eggs.

Moreover, there will likely be foreigners who freeze their eggs in Singapore who may not be reached after returning home.

Another problem is the frozen eggs of deceased patients. Can these be claimed by their widowed spouse or next-of-kin for overseas surrogacy arrangements?

A set of clear directives by the authorities on managing unused and unclaimed frozen eggs in storage is therefore necessary.

One suggestion is to make patients sign a form consenting for their eggs to be disposed of should they die or when they had not paid storage fees for a certain number of years, for example, three years.

Another suggestion is to place a limit on the storage duration of frozen eggs, for example, 20 years. After that, there would be mandatory disposal of the frozen eggs.

PREVENTING UNAUTHORISED USE OF DISPOSED EGGS

Stringent regulations should be enacted to prevent unauthorised use of patients’ disposed frozen eggs without their explicit consent.

Most commonly, disposed frozen eggs are just assumed to be “clinical waste”, so it is convenient to use these for training of new laboratory workers involved in in-vitro fertilisation (IVF) procedures.

Currently, this is a hazy and ill-defined ethical issue, because unlike research and treatment, unauthorised use of disposed frozen eggs for training does not produce a “document trail” that can be easily traced, in the form of patents, journal articles and birth records.

This is a clear violation of the patient’s individual autonomy and privacy, if she had not given prior consent for her reproductive material to be used for such a purpose.

DONATION OF UNUSED EGGS

Another important consideration is the option of donating unused frozen eggs to other patients who are infertile.

In such a case, there are three pertinent issues that must be addressed.

1. Spousal consent

Spousal consent ought to be sought at the time of egg donation to other patients.

No doubt, women freeze their eggs when they are single, but their marital status might change at the time they wish to donate their eggs to someone else.

In that case, the authorities should ensure informed consent from the donor’s spouse, because of the possibility of accidental incest between the couple’s children and unknown donor-conceived offspring. It is only right that he be made aware and consent to accepting such risks for his children.

More importantly, the donor’s husband must also consent to forego any future offspring with the donated frozen eggs.

This is particularly significant if his wife, the prospective donor, is already near or past the age of menopause.

2. Making known lower chances of conception

The prospective recipient patients of the donated eggs must be duly and rightfully informed that chances of conception with the unused frozen eggs are significantly lower than fresh donor eggs, lest they get a raw deal upon spending so much money on IVF treatment.

The freezing process always results in some damage to the egg, however minimal, so frozen donor eggs are not nearly as good as fresh donor eggs.

Moreover, women tend to be much older in social egg freezing, compared to the younger age of fresh egg donors.

The older donor age would thus translate to lower egg quality and hence, reduced chances of IVF success for the recipients.

It is also likely that prospective donors would have utilised their best eggs for their own fertility treatment, so the donated unused leftovers may be of questionable quality.

3. Conflict of interest

There is a conflict of interest faced by fertility doctors in persuading their former patients to donate unused frozen eggs, since they will be earning extra medical fees by performing the donation procedure on other patients.

Moreover, there is also the risk of the doctor-patient fiduciary relationship being abused during the consent process, particularly if doctors know that their former patients are grateful to them for previously successful treatment.

This is why the authorities should ban solicitation of egg donation by doctors on behalf of other infertile patients.

Additionally, fertility clinics should not exercise control over the distribution and allocation of donated frozen eggs to other patients.

Instead, this should be handled directly by the authorities, based on a centralised donor registry and waiting list of potential recipient patients, as is now practised for organ donation in Singapore.

A POSSIBLE ALTERNATIVE WIN-WIN PARTNERSHIP

Perhaps, there could be a better and more efficient alternative to donation of unused frozen eggs.

This could involve infertile women sponsoring the egg freezing of younger fertile women, in return for donation of some of their retrieved eggs, thus leading to a win-win situation for both parties concerned.

On one hand, this would remove the financial constraints on egg freezing for younger women with less accumulated savings and act as an incentive to encourage single women to freeze their eggs at a younger age, which could greatly improve their chances of future reproductive success.

On the other hand, infertile patients receive fresh egg donation from younger women, instead of unused frozen eggs of older women, which would significantly improve their chances of IVF success.

Moreover, such a “freeze and share” scheme would likely reduce the accumulation of surplus unused and unclaimed frozen eggs in storage.

It was reported a few years ago that infertile Singaporean women spend much money on commercialised egg donation overseas, since donated eggs are so difficult to obtain here.

Would it not be better if they instead spend their money in Singapore on subsidising egg freezing for single women in return for donated eggs?

In conclusion, there is a dire need for comprehensive legislation and clear directives for handling unused and unclaimed frozen eggs, if social egg freezing is to be permitted in Singapore.

Otherwise, this would likely lead to unnecessary disputes and unethical practices arising from legal loopholes, as well as undeclared and unresolved conflicts of interests.

Most importantly, these will protect the rights and welfare of patients.

 

[Angelica Cheng]

Key Issues To Consider Before Donating Your Unused Frozen Eggs

Key Issues To Consider Before Donating Your Unused Frozen Eggs — Dr Alexis Heng Boon Chin - CodeBlue

There are profound implications, because an unknown child who is genetically related to you may possibly be born.

codeblue.galencentre.org

 

[Angelica Cheng]

Egg Freezing Package - TMC Fertility

Take charge of your own future now! Our Egg-Freezing package allows you to preserve your fertility until you're ready to start a family.

www.tmcfertility.com

 

[Angelica Cheng]