The terms “delayed motherhood”, “postponed maternity’’, ‘’social freezing” or “elective freezing” appeared not so long ago in the ART world, and despite the active distribution in the US, this procedure still causes some wariness and doubts among women.
If we consider the process allegorically – the preservation of biological material is nothing more than just insurance for the future. Do we get insurance when buying a new car? Certainly! This absolutely does not mean that drivers immediately lose their control and start breaking the rules on the roads. This gives a guarantee if any accident happens – they are secured.
If a woman is not ready to become a mother at a given time, or she has just given birth to her first child and wants to delay the birth of her second one – she has every right to postpone these plans for the future. She will safely and totally fulfill her biological mission when all her social, financial, and career levels will be achieved. And if one day the age as the enemy gets in her way, spoiling all her plans for desire fulfillment, her own oocytes will always come to help. Not the donor’s ones, but her own genetically native cells.
Unfortunately, we get more than wisdom and experience with ages, getting older woman’s eggs to undergo significant changes at a genetic level. Quality of oocytes is critically reduced, and therefore the percentage of pathological and incapable of further development embryos is growing rapidly. At 40 – it is 80%, and at 43 – already 95%. That is, in a woman 43-44 years old we may hardly get an embryo for successful implantation.
Therefore, eggs frozen at a younger age can be a real salvation for these women. The opportunity to temporarily postpone family plans, without prejudice to the health of future offspring, appeared thanks to an innovative method of vitrification – ultra-fast freezing of eggs, sperm, embryos at extremely low temperatures. With this technology, the liquid inside the cells does not crystallize but immediately passes into an amorphous state, which ensures the integrity and viability of the cells after thawing. The survival rate of cells after thawing is quite high – more than 95% and the frequency of pregnancy is almost not inferior to that when using fresh oocytes – about 50%. Vitrified material can be stored in a Cryobank indefinitely. To date, there are no restrictions on the shelf life of biomaterial. There are thousands of case reports on IVF children born after a long-lasting egg and embryo cryopreservation. Evidence-based medicine, RCTs, and metanalyses – all give us a guarantee – kids are absolutely the same as naturally conceived ones!
Initially, the egg cryopreservation had exclusively medical indications, namely, the preservation of biological material before the chemotherapy and radiotherapy application in cancer patients. As it was more widely introduced into practice, the method also developed the non-medical aspects, such as: religious, social, and even urgent, when the indication for oocyte cryopreservation is the inability of obtaining partner’s sperm on the day of follicle puncture.
Today, the social freezing is singled out in a separate medical procedure and can be carried out at the request of a woman in frames of the “postponed maternity” program. Huge corporations even cover expenses for drugs and medical manipulations to their female employees, to motivate ladies for long and fruitful work without breaks for maternity lists.
The program consists of 2 phases:
In the first phase the patient is counseled and examined in order to get if there are any contraindications to hormonal stimulation that exist. Restrictions can be obtained only in case of severe chronic somatic pathology, this will require a more individual approach and, possibly, cell accumulation of eggs in the natural cycle – the so-called “oocyte banking”
After evaluating the results of the examination and ovarian reserve of the patient, an individual ovarian stimulation protocol is assigned. In the case of low ovarian reserve, the mild stimulation can be used. Since the number of eggs received in mild stimulation is not great, the lady can be suggested to proceed with the so-called double stimulation – two rounds of ovarian inductions in one cycle – “Duo-stim’’ or “Shanghai protocol”.
As the follicles grow and get matured, the optimal day for egg collection is set up.
Egg collection is carried out in the most comfortable way for a woman, under the intravenous anesthesia and takes just 15-20 minutes. All the collected oocytes are transferred to the embryological laboratory, where they are carefully washed out, selected, vitrified, and stored in a Cryobank.
The second phase begins when the patient is ready to use previously cryopreserved oocytes. This phase includes preparing the patient for embryo transfer in the natural cycle or using hormonal therapy. Thawing eggs, fertilization, cultivation, and transfer of embryos into the uterine cavity.
According to multicenter studies conducted in Europe, from a financial point of view, delayed motherhood is the most profitable compared to the cost of IVF programs with fresh eggs in older reproductive age, or IVF with donor oocytes.
Thus, a kind of “insurance” in the form of vitrification of their own eggs has several positive aspects:
1) By vitrifying oocytes, the patient provides herself with a reliable, effective, and safe option for preserving the reproductive potential for the future.
2) It is exempted from the psycho-emotional pressure of the need to implement their maternal plans urgently. This is rational planning both career and family future.
3) This is the most profitable use and investment of funds in terms of baby life birth guarantee.
Like any medical direction, delayed motherhood has its opponents. They hold the position of the immorality of shifting the parental period to later years, appealing to the old age and weakness of such parents, as well as to the psychological pressure on the child by the fact that he will lose his parents earlier than other children.
Postponed motherhood is not the propaganda of late birth. Every woman, if she is ready and has a desire, should realize her maternal plans at reproductive age. BUT, if in this moment of her life she is unable to do that – doctors are obliged to provide her with a choice and a real opportunity to postpone her maternity for a favorable period.