Egg Retrieval Process

This all varies depending on age, ovarian reserve and the cause of an underlying infertility issue. Below find information on egg Banking:. Feel free to call my assistant, Patti and set up an online consultation with me.

• EGG BANKING:

“The bottom line is that because of the traumatic effect of freezing on egg viability and “competency” the statistical chance of each frozen/ thawed egg ultimately resulting in a baby is only at best 6-8%. So, while success rates following the transfer of embryos derived from frozen eggs have indeed improved substantially over the last 5-10 years, they remain significantly lower than when embryos derived through fertilization of fresh (not frozen) eggs, are transferred.\”

Since the birth of the 1st “frozen egg baby” in the mid 1980’s, fewer than 3,000 births resulting from the fertilization of thawed eggs have been reported, worldwide. Compare this to > 4.5 million IVF babies born worldwide in the same time period, and > 2,000,000 babies resulting from the transfer of frozen embryos. Harvesting eggs for freezing typically involves giving a woman fertility drugs to stimulate her ovaries to produce multiple eggs, and then harvesting those eggs from her ovaries using ultrasound guided needle aspiration. In average cases (where the mean age of the woman is <36y), it takes about one cycle of fertility drug administration to harvest 10 to 15 eggs.

Presently, in cases where embryos derived from the eggs of women under 35years are frozen, survive the thaw and are transferred to the uterus, the birth rate per embryo transfer is about 35%. In those cases where the eggs were derived from women between 35y and 40y of age, the birth rate is about 25-30% per embryo transfer (ET) procedure. For women of >40y the comparable birth rate per ET is about 10-15%.

While on the face of it, this sounds like a reasonable outcome (especially when it comes to younger women), it should be borne in mind that many eggs do not survive the freeze/thaw and a significant number of those that survive, fail to fertilize. Moreover, of those that do fertilize, a significant percentage fail to progress to the expanded blastocyst stage of development (regarded as being the ideal stage for ET).  That is why depending on their age, women who elect to bank their eggs for fertility preservation (FP) are encouraged to undergo as many egg retrieval procedures as needed in to bank 12-20 eggs before having some degree of confidence, of ultimately being rewarded with a live birth. Since the percentage of eggs that are chromosomally normal (euploid) and “competent”) declines with advancing age, the older the woman becomes, the greater will be the number of eggs (and egg retrieval procedures) needed. . 

In young women, less 50% of eggs are euploid and by the  mid-forties, that percentage drops to below <10%, it follows that potential for a successful outcome using frozen eggs  largely hinges on their chromosomal integrity (“competency”). It follows that ultimately, the success of IVF outcome using frozen eggs will in large part center around the widespread introduction of technology that will provide the ability to accurately identify eggs that are numerically chromosomally normal (“euploid”) and are thus the ones most likely, upon being fertilized and transferred to the uterus,  to propagate a live birth.

In 2005 we became the first to evaluate the chromosomal integrity of the egg, prior to freezing it. We used a procedure where an envelopment of egg chromosomes (the 1^st polar body)  which  is expelled from the egg nucleus following a spontaneous (or GnRHa-induced ) LH surge  or the administration of an hCG “trigger”, is removed (biopsied) and subjected to numerical chromosome analysis. “Competent” (euploid) eggs are those that have precisely 23 chromosomes. Such euploid eggs are then selectively frozen for subsequent banking and dispensation. We were able to show that the likelihood that the transfer of embryos derived through the fertilization of such eggs, improves the baby rate per frozen egg by a factor of 4  . It follows that the selective freezing of only  euploid (“competent”) eggs  could dramatically improve results with egg banking. It would also be most helpful in assisting women undergoing egg banking to determine how many eggs to stockpile for future dispensation with the expectation of ultimately achieving a viable birth. This would be especially helpful in older women and those who have diminished ovarian reserve (DOR) and accordingly would have fewer competent eggs available. The problem is that this process is presently cost0-prohibitive and as such has not been adopted in the present-day clinical armamentarium.

• Indications for egg freezing:
  1. Female fertility preservation (FP)

This refers to the process whereby a woman’s eggs are frozen (cryopreserved) and banked for future use. It has been estimated that the potential demand for FP using frozen eggs exceeds that for conventional IVF by a factor of 4-6 times. The need addresses:

• • • • Women who face a looming prospect of losing their ovarian function – either because of impending menopause, pending surgical removal of their ovaries, and/or exposure to radiation therapy and/or chemotherapy,
      • Women who anticipate delaying or deferring childbearing, ,because of :
        • Career demands
        • Not being ready to commit to a permanent relationship.
        • They feel that by deferring egg banking the ever-advancing biological clock might later render them less able or unable to conceive.
      • Women/couples undergoing in vitro fertilization who are opposed to embryo freezing on moral, ethical or religious grounds.

While the demand for FP is growing rapidly, a word of caution is appropriate here: Women need to be encouraged to bank their eggs at a younger age (<35y) where their chance of the eggs frozen being euploid (“competent”) is greatest and…older women should be cautioned that their ability to propagate viable (usable) eggs diminishes with advancing age. Regardless of age, all should be made aware of the fact that it could take several egg retrievals to generate enough frozen eggs to provide a reasonable chance of subsequently having a baby. Finally, in my opinion, women of >40y (especially those with diminished ovarian reserve-DOR) should be advised against egg banking, primarily because of the inevitability of an age-related decline in egg “competency”. Perhaps some time in the future,  the banking of PGS-tested, euploid embryos will become available to such women and improve their ability to make rational decisions as to whether they should embark on egg banking for fertility preservation (FP).

Herewith are  online links to 2  E-books recently  co-authored with  my partner at SFS-NY  (Drew Tortoriello MD)....... for your reading pleasure:

1. From In Vitro Fertilization to Family: A Journey with Sher Fertility Solutions (SFS) ; https://sherfertilitysolutions.com/sher-fertility-solutions-ebook.pdf

1. Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link ;https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view