WORDS LIM TECK CHOON
Imagine being able to focus on building our career and achieving financial stability without having to worry that time may be running out when it comes to having a family. Perhaps life can be like a romantic movie or novel, and maybe we can wait until we can find that special someone without hearing the biological clock ticking away in our head.
Thanks to advances in fertility methods and technology, we now have options to gain some semblance of control over our fertility (within realistic limits, of course). This month, fertility specialist Dr Agilan Arjunan invites us to take a closer look at these options.
How Long Can A Woman Wait To Have A Baby?
WOMAN’S HEALTH AND FERTILITY WITH
Dr Agilan Arjunan
Consultant Gynaecologist & Fertility Specialist
KL Fertility & Gynaecology Centre
When it comes to fertility, the biological clock is quite real. Dr Agilan shares that:
- A woman’s most fertile period is usually between the ages of 20-25.
- Her fertility begins to decline after the age of 25 (more steeply after the age of 35), often when she is finally ready to settle down and start a family.
Why Is There Even A Biological Clock In The First Place?
While a man’s testicles continuously produce sperm over time, a woman is born with all her eggs already produced, to be released over time during each menstrual cycle.
This means that she has a limited number of eggs that can be used to conceive a child throughout her reproductive years. As we can see from Figure A, a woman has 100% of her eggs at birth,but the number decreases over time. By the time she is 30, she has approximately 10% of her eggs remaining, and the number continues to decline until she experiences menopause, after which she is no longer able to conceive a child.
It’s Not Just The Number That Counts, It’s Also The Quality.
Dr Agilan explains that age doesn’t just affect the number of eggs available for a successful conception. The quality of the eggs is affected too.
“The good quality eggs are often released during a woman’s most fertile age,” he elaborates. As the years pass, there is a higher risk for an egg to contain abnormal genetic material or develop into an abnormal embryo. This is why the risk of having a child with genetic disorders such as Down’s syndrome increases when a woman has a child at a later age (especially after 40).
There Are Other Factors That Also Affect A Woman’s Fertility.
Some of these include:
- Being obese or overweight has been linked to abnormal periods and ovulation as well as reduced chances of successful pregnancy.
- Diet and lifestyle may also contribute to reduced chances of conception.
- Other possible factors that can affect fertility include the presence of pollutants and/or toxins in the environment and stress.
In-Vitro Fertilization Or IVF Can Solve All These Issues, Right?
Sadly, no. No matter how advanced IVF technology may be, it still requires the woman’s eggs. If she has low numbers of eggs, and there are few good quality eggs available, the chances of a successful IVF will be impacted significantly.
Fortunately, there is a way to freeze a woman’s eggs, obtained when she is younger and hence more fertile, which can then be used for IVF when she is at a later, less fertile age.
The Deep Freeze
Dr Agilan shares that, in the past, egg freezing was an option offered to women who were about to undergo cancer treatment. It still is, but with recent improvements being made to the technology, egg freezing is now also an option for women who wish to preserve their younger eggs for later use.
What Has Been Improved About Egg Freezing?
Dr Agilan shares that egg freezing experienced a surge in use after the development of a technique called vitrification. This process allows the egg to be very rapidly frozen in liquid nitrogen. This method greatly reduces the formation of ice crystals that can damage the eggs – a problem that plagued egg freezing prior to the development of the vitrification technique.
Dr Agilan further elaborates that the entire process may take about two weeks, which shouldn’t be too much of a disruption to a busy woman’s routine. He adds that the fertility specialist will try to accommodate the client’s schedule as much as possible.
So, How Much Is It?
The cost may vary from one fertility centre to another. Aside from the usual fees for consultation, injections, medications and the egg harvesting procedure, the fertility centre will charge a fee for the storage of the eggs. If the client has any concerns about the cost, the matter can be discussed with the fertility specialist.
Technology Has Allowed The Freezing Process To Have A Lower Risk Of Egg Spoilage. Hence, Egg Freezing Is Now A More Viable Option To Preserve A Woman’s Fertility.
What Is The Procedure Like?
- Let’s talk about it first. Like most consultations, the fertility specialist will explain the procedure clearly and thoroughly to the client first. Dr Agilan adds that this is a good opportunity for the client to voice any concerns she may have.
Let’s find out how many eggs are there. The fertility specialist may frst conduct a pre-screening test to obtain an idea of how many eggs the client has left (or her ovarian reserve). The knowledge will allow the fertility specialist to determine whether egg freezing is suitable for the client and, if yes, how many eggs would likely be harvested per cycle. Dr Agilan shares that the fertility specialist usually aims to collect about 10 to 12 eggs.
Let’s get the ovaries to work. Once the client is ready, the fertility specialist will offer some injections to stimulate her ovaries into producing a large number of eggs.
Let’s collect the eggs. When the time is right, the fertility specialist will put the client under deep sedation and harvest the eggs using a needle. An ultrasound will be used to help guide the fertility specialist.
Let’s freeze the eggs. The harvested eggs will then be frozen in liquid nitrogen using the vitrifcation process.They will be stored in a safe and clean temperature-regulated area within the fertility centre.
Still Have Concerns? Dr Agilan Dishes Further About Egg Freezing.
How Long Can The Eggs Keep?
The eggs can keep for a considerable length of time so long as they are stored under the right conditions. According to Dr Agilan, the fertility centre typically agree to store a batch of eggs for 5 years.
Can The Fertility Specialist Guarantee The Success Rate When The Eggs Are Used In IVF?
No. Egg freezing serves to preserve a woman’s eggs at a younger age for future use. It doesn’t improve the quality of the eggs or increase the odds of success when these eggs are used in IVF.
What Happens If The Frozen Eggs Are Damaged Or Lost?
When a client agrees to have her eggs frozen at a fertility centre, she will be given a consent form to sign. Details such as accountability will be stated clearly on the form, and the client should read it carefully to make sure that the terms are agreeable before signing on the dotted line.
Details may vary from one fertility centre to another, but usually, the fertility centre cannot be held accountable if the eggs were damaged or missing due to unforeseeable or unpreventable incidents. These include events considered as ‘acts of God’, such as natural disasters. The fertility centre, however, can be held accountable for errors caused by carelessness or negligence.
What Happens If The Fertility Specialist Retires Or Transfers To Another Fertility Centre? Or, If The Fertility Centre Closes Down?
Ethical and responsible fertility centres have contingency plans for issues such as closure. Typically, clients will be notified in advance, and these fertility centres would have made arrangements with another one to take in the frozen eggs.
In the event of a transfer or retirement of a preferred fertility specialist, the fertility centre will be happy to continue the existing arrangement or, if the client prefers not to, help facilitate the efforts to transfer the frozen eggs to a fertility centre of the client’s choice. HT
Hey, how come only women need to plan their fertility? How about the men? Don’t shoot the messenger, but biology isn’t big on equality of the sexes. Unlike women, men continue to produce sperm cells throughout their reproductive period, and hence there is usually no need to freeze their sperm. Dr Agilan says that sperm freezing is often an option to consider if the man is about to go for cancer treatment. Other than that, he believes that there isn’t any need for a man to freeze his sperm. However, do note that male fertility has been decreasing on a global scale, although we have yet to fgure out the exact reasons for this phenomenon. Dr Agilan believes that some men may have fertility issues after the age of thirty, and as such, they should consider visiting a fertility specialist if they had been trying to have a child through regular sexual intercourse for a year or so, but have yet to be successful.
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