What you should know about social egg banking

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What is Social Egg Banking?

Social Egg Banking (SEB) is a medical treatment for well women who wish to harvest some of her existing eggs to be frozen (in liquid nitrogen), as a form of fertility preservation. This utilises current knowledge and technology of assisted reproduction techniques (used in IVF), to stimulate, mature and harvest eggs for freezing. In time to come, when the woman is ready to conceive, these eggs may be used in IVF, to create embryos for transfer into her womb.

Why bank eggs?

Some may consider the womb to be the most important reproductive organ to preserve, but the womb does not deteriorate like the egg reserve, nor is there any practical means to preserve the womb itself, against the ravages of disease or ageing. Furthermore, compared to the inevitability of menopause (total depletion of eggs), only a very small number of woman are affected by the loss of the womb function during their reproductive years.

Unlike men, who continue to produce sperm throughout most of their adult life, women are born with a finite amount of eggs, which will only last them about 20-25 years of their reproductive life. As the quantity reduces with advancing age, the quality of these eggs deteriorate too. Eggs stored in the ovaries cannot be fertilised unless they split and divide their genetic contents into 2 equal portions. With advancing age, this “splitting mechanism” of the egg cells become more prone to errors, resulting in unequal division of the genetic contents, hence the resultant (fertilisable) eggs are more likely to be genetically abnormal. The natural decline in quantity and quality becomes accelerated from the age of 35-37 years onwards, in normal women. In some women, certain disease processes and medical treatment (including surgery near or on the ovaries) may levy extra insult on the eggs, leading to a steep decline regardless of age. Therefore, to safeguard the fertility of a woman, the most important factor to “preserve” would be her eggs.

As we embrace the societal norm of delaying marriage and childbirth, an artificially aggravated “disease state” is create — age-related female infertility. An older woman is less likely to give birth to a healthy child, as the chances of conceiving is lower with less eggs and the risk of abnormal eggs resulting in miscarriage increases drastically with advanced age. Hence the treatment for age-related female infertility is to freeze eggs when they are plenty and of better quality.

How to bank your eggs?

SEB should only be performed by accredited fertility specialists, experienced in the techniques of IVF treatment. As SEB is a preventive treatment performed on otherwise healthy women, additional care must taken to minimise complications. Egg maturation treatment, mirrored from IVF regimes, are tailored to suit the profile of the woman (taking into account the age, egg reserve and existing disease states), to strike a balance between optimal yield of eggs, minimal risk and cost-efficiency.

Once the eggs are mature, they can be harvested in accredited IVF Centres for storage in liquid nitrogen. When in the frozen state, the eggs do not deteriorate, but the process of thawing them for IVF use has a certain attrition rate, therefore you will have to be prepared to have less usable eggs than the number obtained for freezing.

Who should bank her eggs?

Biologically, the young woman in her early twenties will be the best candidate to bank her eggs, as she has large quantities of good quality eggs. However, the lack of awareness, financial prioritisation and focus on other aspects of life (such as studies and career) means most women in their twenties will not be considering egg banking as a priority. Ironically, it is the older woman, after failing to conceive for years, or upon diagnosis of disease affecting fertility, who will then actively seek out this preventive treatment. Some may argue that she might be too late.

However, even though the number of eggs to be banked is less in this age / state and of lower quality than when she was younger, it is invariably better than less or none when this treatment is attempted later. Therefore, the best woman to bank her eggs is anyone who still has eggs and have desires to start a family later (not currently).

What happens after your eggs are banked?

Once the mature eggs are retrieved from the ovaries via a simple procedure under anaesthesia, they are then processed and cryopreserved (frozen) for future use. These eggs are keep frozen in liquid nitrogen at the fertility centre of your choice, until you are ready to thaw them for use. There is no need for long term follow up treatment pertaining to the banked eggs, after recovery from procedure.

Women who bank their eggs when they were young may not eventually require to use these banked eggs to conceive, unless they only try to conceive after their egg reserves have been depleted by advance age or disease. Older women who do bank their eggs, would then logically be more likely to utilise these eggs for IVF later, when they are ready to start a family.

So long as the banked eggs remain deep frozen in liquid nitrogen, they should not degrade even after years of storage. However, upon thawing, some women may experience half or more of these eggs being damaged or are not of usable quality.

What are the risks and drawbacks of social egg banking?

Regardless of the objective of the treatment, be it preventive in a well woman, or therapeutic for a subfertile woman, the egg preparation / maturation still requires the use of stimulatory hormones and depending on the profile of the woman, some may have excessive response leading to Ovarian Hyper Stimulation Syndrome, while some may have poor response requiring cancellation. The procedure of egg retrieval, although is a quick and simple procedure, is still an invasive undertaking with small risks of causing bleeding, injuries, infection and discomfort.

The perennial concern with SEB is to have a (false) sense of security from having banked eggs for future use; this may lead to even longer deferment of pregnancy, giving rise to other medical complications during pregnancy in women of advanced age, invariably with poorer outcomes.

The non-selective basis of SEB means that any woman within the legal age limits for SEB may choose to bank her eggs, regardless of her medical status or intention for childbirth. This might lead to an overwhelming volume of cases, potentially shunting limited medical resources from the treatment of truly infertile women. Given the relatively expensive nature of this preventive treatment, it would be reasonable to assume that most women who embark on this endeavour will likely be of higher socioeconomic status, hence further widening the socioeconomic divide.

Will you have significantly less eggs or infertility after SEB?

The number of eggs that a normal woman has at puberty is expected to be in the range of about 300,000. The range of number of eggs retrievable at every SEB cycle is likely to be between 10-30, hence it is extremely unlikely to have any significant impact on egg reserve, even if a young woman undergoes 1-3 SEB cycles. Short of the rare catastrophic complications during the egg retrieval procedure, causing severe damage to the ovaries, SEB in the heathy young woman should not contribute to any appreciable decrease in egg reserve, nor is it going to lead to infertility.

Should YOU bank your eggs?

The reproductive medicine fraternity and countless activists have been lobbying for many years to have SEB made available to the general public. Now that it is finally here, the dilemma is whether the healthy young woman should actually bank her eggs. This question is much easier to answer for the older woman, who is planning to defer her childbearing endeavour - yes, please do consider SEB. Now.

But for the young women who are seemingly healthy, for the first time, they can choose to be a patient and receive treatment, instead of letting a disease dictate that choice. Making this decision is not an easy task; a good start would be to consider getting a fertility screen done with an experienced fertility specialist / fertility surgeon, to make sure that you are indeed healthy from the fertility perspective. Next, some sort of life planning has to be made; if you do not intend to conceive before 35 years old, SEB might be a good idea. If you are not sure whether SEB is suitable for you, do consult a suitably trained fertility specialist / IVF gynaecologist to help you with the assessment, before you make your decision.

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