This article is published in number 14 of Vanity Fair on newsstands until April 5, 2022
Young women engaged in their studies, looking for work or taking their first steps in the profession, who have not yet met “the right person”. Women who travel, discuss and learn about the opportunities that the progress of science makes available to them. Women who, by necessity or by choice, postpone the age of first pregnancy and who today can choose to preserve fertility through cryopreservation of oocytes, the technique – also known as egg freezing – which allows you to freeze your gametes at -196 ° for later use, when there will be a more appropriate time to start a pregnancy. It is already widespread in the United States and other European countries, but in Italy there are still few girls who opt for this solution. “Information is scarce, there is fear, yet we have the need to preserve it all right, considering that we are the European country that has the most first pregnancies after 40 years”, explains the gynecologist Daniela Gallianodirector of the Clinic specializing in Reproductive Medicine IVI From Romeand author of the book How I Wish You – How Medical Science Helps You Have a Child (Piemme Editions). “The point is that while society has changed, biology cannot change: after 35, the ovarian reserve decreases. And fertility is inevitably halved ».
How can egg freezing help in this regard?
«It allows you to take your gametes at an optimal age, that is between 20 and 35 years, and store them in liquid hydrogen, keeping all the properties intact until the moment of thawing. All this in anticipation of a pregnancy that could be sought even after the age of 40 for various reasons, including the need to face treatment for specific gynecological pathologies or for a tumor “.
Is this technique therefore also recommended for cancer patients?
“Yes, more and more frequently. Chemotherapy and radiotherapy are toxic to the ovaries: if the eggs are not preserved, the tumor will be cured but in all probability you will remain sterile. For this reason, young patients arrive at the clinic, referred to by the oncologist, whose ovaries are stimulated with ad hoc protocols, so that in about ten days both sampling and freezing can be completed, allowing them to begin treatment ” .
In what other cases is it advisable?
“In the presence of stage 3 or 4 endometriosis or even stage 1 endometriosis, if the patient is to undergo laparoscopy for the removal of endometriotic cysts, which would reduce healthy ovarian tissue. And then, in the case of ovarian failure at a young age ».
In general, what is the procedure to follow and how is the withdrawal carried out?
«The first step is to book a visit with a fertility specialist: it will require a series of analyzes, on the basis of which the treatment to be followed is decided. It then starts with the menstrual cycle, the moment in which ovarian stimulation begins through the administration of hormones. With specific ultrasound scans, the increase in size of the follicles occurs and when the oocytes reach the desired number and size, ovulation is induced, scheduling the sampling, which takes place 36 hours later. The oocyte aspiration is performed in the operating room under deep sedation and takes about 15 minutes. Immediately afterwards we proceed with the freezing ».
Is there a minimum quantity of oocytes necessary to ensure fertilization?
«From our IVI studies, carried out over time, it has emerged that if you are under 35 and at least 10 mature oocytes the chances of a future pregnancy are around 60 percent. 10 oocytes is therefore the minimum quantity necessary, but in general it is possible to collect even 20 ».
How does post thaw fertilization take place?
“In vitro, with a semen sample. Embryos are obtained which are then transferred to the uterus with a short painless procedure, after having made the patient’s endometrium grow with a very soft hormonal therapy “.
Where and until when are the oocytes stored?
“They are collected in special” banks “which are normally found in the clinic or center where they were collected and where they can be kept without a deadline”.
And up to what age can they be used for fertilization?
“The law does not impose age limits, but the reproductive medicine societies in Europe and the United States have agreed on the age limit of 50. This happened many years ago and today we tend to evaluate pregnancy even in women who are 51 years old, without any pathology, with the consent of the attending physician who certifies their state of health “.
What happens if the eggs are never used?
«They can be donated or disposed of, upon written request, since they are simple cells. This is unlike embryos, which by law, in Italy, must always be preserved ”.
What are the costs of cryopreservation?
“If it is used for an oncological cause, freezing is free. In all other cases, it has a standard cost of around € 3,000 and includes counseling, treatment, egg pick-up, freezing, future thawing and 2 years of maintenance. After the first two years, the annual cost for maintenance is instead around 300 euros “.
There are cases where theegg freezing it’s impossible?
«When you are in premature menopause, because the ovarian reserve is now reduced. If there are cases like this in the family, it will therefore be better to keep them at the age of 20 ».
What happens if women over 35 ask for freezing?
«As already highlighted, up to the age of 35 is the recommended age, the one within which the best results are obtained. Afterwards, it is possible to do this by evaluating the ovarian reserve, but it is well explained that the effectiveness of a fertility preservation program is inevitably based on the age of the patient and the frozen oocytes. The main problems are the quality and quantity of oocytes which decrease with age and the incidence of Down syndrome or chromosomal abnormalities which increase. Having a lot of good quality oocytes, and a minimized percentage of chromosomal abnormalities, is possible at 20 years of age. But, in fact, who is it today who has a child at this age? ».
Cryopreservation, some references
Hospital facilities. Egg freezing can only be achieved with the NHS for cancer diseases. It is performed in a hospital, if equipped, or in a support center indicated by the reference oncologist.
IVI clinics for medically assisted reproduction. In Italy, they are present in Milan, Rome and Bari. Information: ivitalia.it and toll-free number 800 088 247
Reproductive Medicine Centers GenerateLife. In Turin, Milan, Bergamo, Marostica (VI), Genoa, Bologna, Cattolica, Forlì, Florence, Umbertide (PG), Rome, Naples. Information: generalifeitalia.it/contatti/
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Source: Vanity Fair
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