A woman’s fertility is at its highest in her twenties, but for many women having a baby at this stage of life is not an option, and many are now planning to start families in their late 30s.
It can get harder to conceive as a woman gets older; her chances of miscarriage also increase. This is because the number and quality of the eggs in the ovaries declines rapidly after about 35 years of age.
The effects of these changes are best illustrated by the national IVF figures, provided by the HFEA’s published data (2009 – 2010 Published 2012), showing that the success of IVF also declines with increasing age for example at under 35 years the live births per cycle started was over 30%, at 38 years it is around 20% and over 45 years that figure drops below 5%
We know that the success of IVF in an older woman using eggs donated from a younger woman generally depends on the age of the donor. A ‘young’ egg is more fertile, and the resulting embryos have a better chance of implanting successfully.
Vitrification for fertility preservation
The human egg is a very large cell. Until recently we didn’t have technology advanced enough to freeze (and thaw) eggs safely. Ice crystals tended to form, causing damage to the cell. However with vitrification, the technology has improved. We can now vitrify eggs without losing their viability, so that they can then be stored and used later. Here at the GCRM, we offer fertility preservation: women go through the IVF stimulation and egg collection processes, but instead of being mixed with sperm the unfertilised eggs are frozen.
The technology is relatively new but the results are encouraging, such that units around the world are achieving 25% pregnancy rates using frozen (vitrified) mature eggs. This compares favourably with the success rates for IVF cycles, in patients of the same age. The number of babies born following these procedures is increasing all the time.
Declining fertility is due to the age of the eggs, and therefore fertility preservation is most effective if a woman is young when her eggs are frozen. Nevertheless, it could have a place for women in their mid-30s or older who do not want to have a family just yet. If you feel that fertility preservation might be for you, you can learn more about what is involved below, or download a factsheet.
Putting your fertility on ice is very similar to the start of a standard IVF cycle. It involves a course of daily fertility drug injections for approximately 2 weeks followed by a procedure to remove the eggs. You can see a full patient journey here
The eggs are then carefully vitrified and put into store in liquid nitrogen at -196°C. They can be kept under these conditions without deteriorating for an indeterminate length of time.
Thawing, insemination, incubation
When you decide that it is time to use these eggs, they will be thawed at the appropriate time of your menstrual cycle and inseminated with a single sperm using intracytoplasmic sperm injection (ICSI). The cells are then placed in an incubator so that fertilisation can take place.
All being well, one or two successfully developed embryos will be transferred to your womb a few days later.
Objective statistics and expectations, using vitrification
These simple statistics are based on a single treatment cycle yielding enough eggs to provide a reasonable chance of success. If you respond well to stimulation treatment so that we collect 10 eggs, we would expect that 8 of these, on average, will be mature and suitable for freezing.
We would anticipate that 7, on average, would survive the freezing and thawing processes successfully. Upon thawing, the eggs are subjected to ICSI and fertilisation would be confirmed the next day. We can estimate that there would be approximately 5 viable embryos. On average, depending upon the age of the egg at freezing, each of those viable embryos has a 15-30% chance of leading to a live birth. Therefore, the original group of 10 eggs should lead to a 50-70% chance (cumulative) of a live birth.
Of course there will be wide individual variation around each of these figures, but they do indicate the potential success of the treatment. Younger women could expect to produce more than 10 eggs, each of which would have a higher expectation of implantation than those of older women. Hence, the younger the woman at the stage of egg vitrification, the better the results that can be expected. The age of the woman at the stage of thawing and implantation has a negligible impact upon outcome.