The cryopreservation of oocytes as a precaution (also called " social freezing ") can be defined as a treatment for future infertility. It is the application of the traditional techniques of cryopreservation of female gametes (eggs), which are now well established and secure processes. The gametes are stored for future procedures of medically assisted procreation if the patients are not able to conceive spontaneously. It is indicated and required by women who wish to preserve fertility and seek a pregnancy later in time, when they might have difficulties in conceiving naturally or suffer a reduced fertility.
Moreover, fertility preservation is offered to those women who have to undergo chemotherapy or radiotherapy for cancer of the pelvis, or treatment interventions and demolition appendages that irreversibly affect the reproductive capacity. Finally, it is also indicated in cases of familiar to early menopause.
What is "social freezing"?
The treatment is divided into several phases: interview in a specialized centre for the couple's infertility and the Medically Assisted Procreation (MAP) assessment of ovarian reserve by determining hormone (AMH, FSH, 17 beta estradiol in menstrual phase) and transrectal, vaginal ultrasound with counts of antral follicles and ovarian volume measurement. In addition, diagnostic and infectious diseases tests are provided, induction multiple ovulation, ultrasound and hormonal monitoring of ovulation, removal of oocytes, which are frozen in liquid nitrogen (-196 degrees) and stored.
Which patients can undergo social freezing?
The possibility of future pregnancy using cryopreserved oocytes depends on the number and quality of oocytes retrieved. In general, these factors are due to age and ovarian reserve of the patient at the time of collection.
Disorders such as diabetes or high blood pressure do not preclude the possibility to undergo assisted reproductive technologies, but should be carefully monitored.
How is cryopreservation performed?
Cryopreservation is the final stage of a articulated procedure performed mostly in outpatient settings, which ends with egg retrieval and in-patient treatment and includes:
- Preliminary investigations including hormone assay for assessment of ovarian reserve and transvaginal ultrasound in menstrual phase with the measurement of ovarian volume and antral follicle count.
- Induction and monitoring of ovulation. The woman is given hormone therapy, subcutaneous injection, which allows the simultaneous maturation of more follicles. Serial transvaginal ultrasound is performed to evaluate the size and number of follicles and hormonal assays of plasma estradiol and progesterone.
- Withdrawal of oocytes. Performed through guided, transvaginal ultrasound and analgesia or sedation.
What are the advantages and disadvantages of social freezing?
Social freezing allows the possibility of obtaining a pregnancy at different times using their own cryopreserved gametes. Currently, numerous scientific studies have taken into account the thousands of cases and pointed out the absolute safety of the procedure and results, even after a long time.
In contrast, the treatment requires women to undergo a hormonal treatment to stimulate ovulation with minimal side effects including the risk of ovarian hyperstimulation syndrome.
Is the treatment painful and/or dangerous?
All treatment processes, from picking to transfer an embryo into the uterus, which results from fertilization of the oocytes, are usually painless.
The sampling is typically conducted under sedation or analgesia with minimal complications. The anaesthetic risk is limited due to the presence of a staff of competent anaesthetists and still it is less than 0.24%.
The phase of ovarian stimulation involves the effects connected with the recruitment of synthetic hormones ranging from mild water retention to moderate pain in the adnexal headquarters.
The ovarian hyperstimulation syndrome is a condition that occurs rarely and it increases the size of the ovaries related to grades of ovarian stimulation; It may involve the swelling of the abdomen, and alteration of certain haematological parameters, and in severe cases, hospitalization (<1% in our experience), but it is more frequent in those women who, after stimulation with excessive response and subsequent embryo transfer, achieve a pregnancy. Currently the protocols involve adequate applied stimulus to minimize this event.
The recent introduction of special pens for self-administration of gonadotropins has facilitated therapy and increased patient compliance.
The collection of oocytes has an average duration of about 15 minutes. The patient is kept under observation and released after several hours. At discharge, it is recommended that the patient leave with a family member. Moreover, it is recommended to remain at rest at least until the next morning.
Standards of preparation
The afternoon before admission the patient must perform a disposable vaginal lavage with iodine and take two tablets of charcoal. The night before the treatment the patient must follow a light diet (pasta and cooked fruit), perform a disposable vaginal douche with iodine, insert into the vagina 1 tablet of chloramphenicol (500mg) or clindamycin (100mg) and fast (including water) from midnight the night before until the exam.
On the morning of admission, prior to the exam lavender, disposable vaginal lavage with iodine must be performed. It is important that the patient follows the doctor’s instructions.