Delayed motherhood: is it really that simple?29.08.2022
In recent years, there has been a trend among young women and couples to delay childbearing. The desire to make a career and gain material independence, the unstable situation in the world, the emergence of the childfree ideology – all this affects the life plans of a woman.
There are also objective factors that complicate, primarily for women, the solution of the problem of childbearing. When a woman wants to become a mother, but cannot find a suitable partner, forced childlessness puts her in a state of chronic stress, and this does not have the best effect on her health.
Of course, there is a medical solution in the form of the use of donor sperm. But we all understand well that a woman will strive to look for her “half” for the longest possible time. How much time does she have anyway?
Together with the obstetrician-gynecologist, reproductive specialist at Ecofamily Clinic , candidate of medical sciences, Victoria Leonidovna Gordeeva, we understand the main issues that accompany delayed motherhood.
Is the number of eggs unlimited?
The number of eggs (oocytes) in each woman is determined at birth and has a limit. It is individual and depends on both genetically determined and external factors, and is laid in the period of intrauterine development of the girl. After birth, the number of oocytes in the ovaries of a girl reaches 1.5-2 million, then it progressively decreases throughout her life. In addition, with age, the number of errors in DNA division increases, and this increases the risk of genetic pathology in offspring.
What is egg cryopreservation
If a woman decides to postpone motherhood indefinitely, then a reasonable decision would be to contact a specialized clinic for egg preservation. Doctors will consult a woman, conduct an ovarian stimulation program and a procedure for cryopreservation (freezing) of eggs. This procedure will become the insurance of her reproductive function for the coming years.
The presence of such an opportunity is also necessary for patients who are to undergo ovarian surgery for volumetric formations of various etiologies, for example, endometrioid cysts.
How painful it is to see a young woman at the reception who comes with an extract after surgical treatment associated with resection of ovarian tissue. At the same time, her ovarian reserve is extremely reduced, and sometimes there is no menstrual cycle. And this is not the fault of the surgeons. In most cases, specialists did their job well, and doctors do not always have the opportunity to save ovarian tissue during surgery. But if the doctors had referred the woman to a reproductive specialist before the operation, they would have been able to save her own oocytes and give her hope for the birth of a child.
A special place is occupied by the issue of fertility preservation in cancer patients. If the patient is to undergo toxic therapy for an oncological disease, she should consult a reproductive specialist. He, together with the oncologist, will discuss the option of how the patient does not lose her reproductive function.
In modern conditions, the method of vitrification – rapid freezing – allows us to hope for the successful thawing of most oocytes.
Questions and myths about cryopreservation
But is everything so cloudless and stable when oocytes are cryopreserved for their delayed use? Let’s talk about how the oocyte cryopreservation procedure looks like and what prospects it gives for the future.
How many eggs do you need to freeze to feel confident and be at least partially protected from future infertility problems?
It is extremely important to understand that the older the woman, the more oocytes will be required to obtain one embryo with a normal number of chromosomes. Maximum success in achieving pregnancy after thawing of oocytes can be achieved if this procedure was performed before the age of 35 years.
The optimal number of oocytes to be frozen for women under 38 is 20 cells; if less than eight cells are preserved, the chances of success are significantly reduced. And patients older than 42 need to freeze already 60 oocytes. For this, three procedures of stimulation and extraction of eggs are carried out.
Why is ovarian stimulation necessary if a woman has a stable menstrual cycle and no gynecological problems?
Even if the specialists of the clinic perfectly perform the procedure of cryopreservation of oocytes and follow all the necessary methods during thawing, some of the cells may lose their original qualities and become unsuitable for fertilization.
Related to this is the need for ovarian stimulation, because it greatly increases the chances of getting some good quality oocytes when defrosted. It is technically possible to puncture a single ovarian follicle in a natural cycle and freeze one oocyte, but this drastically reduces your chances of a favorable outcome.
How long can oocytes be stored?
Fertility specialists have accumulated experience of storing oocytes within 15–20 years, it varies depending on the country and the experience of the clinic. Attempts to cryopreserve and preserve oocytes have been carried out for a long time, but only since 2012 the technique was recognized as non-experimental and it has been widely used in the world.
In my practice, the longest storage of oocytes, followed by fertilization and pregnancy, was 11 years. When IVF was attempted 11 years ago in spouses with severe male infertility, some of the wife’s oocytes were frozen, because during the operation the husband managed to obtain a limited number of spermatozoa and not all of the eggs were fertilized. The patient became pregnant and gave birth to a wonderful baby girl.
Circumstances so developed that a few years later the couple broke up. The woman remarried and went to the clinic about the desired pregnancy. She was 39 years old and her functional ovarian reserve was very low. At this point, her cells, which she kept at the age of 28, came in handy. After thawing and fertilization of the cells, only one embryo was obtained, which, fortunately, turned out to be the very precious one that gave the long-awaited pregnancy.
What else is important to remember for a woman who has undergone the procedure for cryopreservation of her eggs
In the course of life, we all inevitably accumulate a load of various problems and chronic diseases, which, without annoying us in ordinary life, may suddenly appear when pregnancy occurs. Carrying a pregnancy at 25–35 years and after 40 is significantly different. But this is a topic for a separate discussion.
Therefore, despite the fact that the clinic has an excellent supply of your oocytes, you must remember how important it is not just to get pregnant, but also to carry the baby safely. To do this, we recommend leading the most healthy lifestyle, that is:
- be responsible for your health and visit doctors on time;
- stop smoking and drinking alcohol;
- eat a balanced diet;
- do sport.
And yet, as a doctor, I want to turn to you, dear, dear women: do not overestimate your strength, do not put off a wonderful moment in life – the birth of a baby at a late reproductive age, and then you will have the opportunity to enjoy the joy of motherhood to the fullest.
- Catrin E. Argyle, Joyce C. Harper, Melanie C. Davies. Oocyte cryopreservation: where are we now? Hum Reprod Update. 2016 Jun;22(4):440-9. doi: 10.1093/humupd/dmw007.
- Joseph O. Doyle, Kevin S. Richter, Joshua Lim, Robert J. Stillman, James R. Graham, Michael J. Tucker. Successful elective and medically indicated oocyte vitrification and warming for autologous in vitro fertilization, with predicted birth probabilities for fertility preservation according to number of cryopreserved oocytes and age at retrieval. Fertil Steril. 2016 Feb;105(2):459-66.e2. doi: 10.1016/j.fertnstert.2015.10.026.
- Filippo Maria Ubaldi, Danilo Cimadomo, Alberto Vaiarelli, Gemma Fabozzi, Roberta Venturella, Roberta Maggiulli, Rossella Mazzilli, Susanna Ferrero, Antonio Palagiano, Laura Rienzi. Front Endocrinol (Lausanne). 2019 Feb 20;10:94. doi: 10.3389/fendo.2019.00094.