Nowadays, an increasing number of women are freezing their eggs worldwide.

But before you get all excited about this new technology, know that it is not a decision that you should take lightly. 

Egg freezing is a method used to preserve a woman’s ability to get pregnant at a later stage in her life – whether for medical reasons such as cancer treatment or for social reasons such as career, studies, or no partner.

The procedure involves:

• Stimulating the ovaries with hormones to produce multiple eggs
• Collecting the eggs from the ovaries
• Freezing the retrieved eggs in liquid nitrogen
• Storing them in tanks (at subzero temperatures)
• Thaw them and fertilize them in the future. 

Some Keys to Consider Before the Procedure

Here are some key things to consider if you are thinking about freezing your eggs: 

1. Eggs Should Be Frozen Ideally Before Mid 30s

As you get older, your eggs decrease not only in quantity, but also in quality.

The average age at which women freeze their eggs is around 37.

However, the highest Live birth rate from previously frozen eggs has been shown to come from women who undergo the procedure before they are 30. 

Freezing your eggs in your early 20s may result in a good number of high quality eggs.

However, you are unlikely to know at this age if you will ever need to use them, as you may be able to conceive naturally. 

In your early 30s, egg number and quality remain relatively high.

However, around the age of 35, women need to freeze more eggs than younger women for the same chance of future pregnancy because 20% of the eggs are lost during the process. 

So for a better chance of pregnancy success in the future, it is best to freeze your eggs before you reach the age of 36. 

2. You Might Require Several Treatment Cycles

Ideally, women should freeze around 8 to 15 eggs to have a reasonable chance of future pregnancy. 

However, the number of eggs collected during one cycle of treatment depends on:

• how your body reacts to the fertility drugs
• your age at the time of undergoing the procedure
• your ovarian reserve. 

So keep in mind that you may be among those who need to go through multiple cycles to get a good amount of eggs to freeze. 

Besides, the process of egg freezing is not only expensive, but can also be physically and emotionally draining.  

3. Success Rates Aren’t High

Once your eggs are retrieved, it is important to be aware that not all your eggs will be mature enough for freezing. 

Furthermore, you cannot know about the quality of your frozen eggs until they are thawed and used. 

There’s a lot of room for failure when you’re freezing eggs.

In order to lead to a successful pregnancy:

• The egg must be mature
• It should survive the freezing process/thawing process
• The egg should successfully get fertilized
• The fertilized egg must divide and become an embryo
• The embryo must get transferred into the uterus
• The embryo must implant successfully in the uterus   

So a successful pregnancy is not always guaranteed with frozen eggs.

While younger women lose approximately 10% of the eggs they freeze to the process, older women can expect to lose 20%.

This is because eggs are less metabolically robust when frozen later in life.

4. Not All Clinics Are Credible

Make sure you pick a clinic that has plenty of experience with the procedure and high success rates in achieving fertilization and pregnancy with frozen eggs.  

Ask the clinic to provide you with success rates from their own data and not only based on published articles and data from other clinics. 

Make sure the clinic adopts the new method of egg freezing known as vitrification, and has all the material and media needed for the procedure.  

Earlier egg freezing methods were less successful, as they used a “slow-freeze” process that sometimes formed ice crystals in the eggs and damaged them. 

Vitrification is a super-quick freezing process that doesn’t allow ice crystals to form.

It allows the eggs to successfully get through the freezing, thawing, and fertilization process. 

Personally and professionally, I definitely think that egg freezing is a great idea for anyone who is considering having children in the future.

However, take your time to fully research your options.

Also, keep in mind that if you don’t freeze your eggs, you do have other possible roads towards parenthood.

Read our article on How to Ensure You Have the Right Gynecologist.

If you have any questions don’t hesitate to contact me. 

During IVF (in-vitro fertilization), the healthiest embryos are chosen and transferred to the woman’s uterus through a catheter. 

But how to determine which embryos to transfer? 

Embryos created in the lab during IVF are graded by the embryologist to distinguish between a good, an average, and a poor quality embryo, so that the one with the highest chance of becoming a baby is transferred.  

Embryo transfers normally occur either 3 days or 5 days after fertilization. 

In fact, there are different grading systems for day 3 embryos and day 5 embryos because embryos are developmentally different on these days.

Day 3 Embryos

Day 3 embryos are referred to as “cleavage stage” embryos because the cells in the embryos are dividing.

At this stage of development, embryos are graded based on:

• The number of cells in the embryo
• The symmetry of the cells in the embryo
• The degree of fragmentation

The number of cells in the embryo

Theoretically speaking, embryos would divide in a specific sequence: 1 cell becomes 2 cells, 2 cells become 4 cells, 4 cells become 8 cells, and so on… 

At this stage, the cells are known as blastomeres. 

However, not all good quality embryos follow this specific sequence.

Some embryos will have 3, 5, or 6 cells, and that’s because cells don’t divide synchronously. 

At day 3, a good embryo should ideally contain between 6 and 10 cells or blastomeres.

The symmetry of the cells in the embryo

The presence of blastomeres of unequal size (> 20% difference) in embryos signifies that there might be a high probability of chromosomal abnormality. 

Therefore, embryos with significantly uneven blastomeres are less likely to be selected for embryo transfer.

At day 3, a good embryo should ideally have blastomeres at equal size (or slightly uneven).

The degree of fragmentation

As embryos divide, sometimes a small portion of cytoplasm breaks off and forms fragmentation.

Think of fragmentation as crumbs when a piece of bread is broken apart.

Less than 20% fragmentation in human embryos is common and fine. 

However, embryos containing a lot of fragmentation lose too much cytoplasm and are less likely to be selected for transfer. 

At day 3, a good embryo should ideally have no fragmentation (or <20%).

Day 5 Embryos 

Day 5 embryos are referred to as “blastocyst stage embryos” because it is the stage of development that the embryo must reach before it can implant in the uterus.

A defining moment in embryonic development is when fluid starts to accumulate between cells at the morulae stage of development.

As the fluid’s volume increases, a cavity appears gradually forming the blastocoel.

This normally happens between Days 4 and 5 in human embryos in vitro and marks a new ‘era’ in the embryo’s life, the blastocyst stage.

The blastocyst differentiates into:

1. The inner cell mass (ICM)
2. The trophectoderm epithelium (TE)
3. A fluid‐filled cavity called the blastocoel

ICM are the cells that will develop into the actual fetus, the TE will eventually become the placenta, and the blastocoel will become the yolk sac.  

At this stage, embryos are graded based on:

• The degree of cavity expansion
• The appearance of ICM
• The appearance of TE

The degree of cavity expansion

Fluid starts to accumulate between the cells. 

As the fluid’s volume increases, the cavity appears gradually within the zona pellucida – the thick membrane surrounding the embryo before implantation.

The expansion of the fluid-filled cavity (blastocoel) relates to how large the blastocoel is. 

Grades range from 1 to 6, with 6 being the most developed.  

A good grade embryo will be one with a large cavity expansion.

Examples of the expansion grades are:

Early blastocyst (Grade 1) in which the cavity is less than half the volume of the embryo.

Expanded blastocyst (Grade 4) in which the cavity is greater than the original volume of the embryo and the ZP is thinned. 

Hatched blastocyst (Grade 6) in which the embryo has completely hatched from the zona pellucida. 

The appearance of ICM

The ICM can range from being very large with tightly packed cells to almost non-existent with loosely bound cells. 

Accordingly, the ICM has been categorized into three morphological categories:

Grade A: in which ICM contains many cells that are tightly packed together

Grade B: in which ICM is composed of several cells that are loosely grouped (may be grainy in appearance)

Grade C in which ICM contains very few cells that are loosely bound

A good grade embryo is one with a large ICM that has many cells tightly packed together. 

The appearance of TE

The TE cells play a key role in embryo implantation in the uterus.

They are scored in a similar way to ICM: 

Grade A in which TE contains many tightly packed cells of equal size

Grade B in which TE is composed of a loose layer of cells (irregular and grainy in appearance)

Grade C in which TE contains very few cells that struggle to form a cohesive layer

A good grade embryo is one with uniformly-sized cells in the TE. 

Conclusion:

Embryo grading is a tool that helps embryologists determine which embryos will most likely lead to a successful pregnancy after IVF. 

It is taken into account along with a host of other factors such as your age, fertility history, the day of transfer, and the number of embryos to transfer. 

If you are undergoing IVF, read our article Would You Tell People You Are Doing IVF? and always make sure you ask about the grades of your embryos to be transferred.

But stay hopeful because you may see many cycles fail after transferring 3 perfect looking embryos, and you may also see beautiful babies born after transferring only one “low grade” embryo. 

No matter the grading system, the embryo grades do not tell us what happens inside the embryo genetically. 

So in case you have had several miscarriages or you’re afraid to pass on a genetic disorder to your baby, your embryos can undergo a preimplantation genetic screening (PGS), so that only healthy embryos are transferred to the uterus for implantation.

If you are pregnant or breastfeeding, you may be wondering whether you should take the covid-19 vaccine or not. 

A recent study has shown that breastfeeding women who have received the Pfizer vaccine have antibodies in their breast milk, which could help protect their babies.

Let’s tackle a few questions regarding the vaccine together before you can decide for yourself. 

Are Vaccines Normally Used in Pregnancy?

Pregnant women and women who are breastfeeding are already routinely and safely offered vaccines in pregnancy. 

Non-live vaccines such as those against flu have previously been shown to be safe in pregnancy.

Many of these vaccines also protect the babies from infection. 

Are Covid-19 Vaccines Considered Safe in Pregnancy?

There is limited information about the effects of COVID-19 vaccination in pregnancy. 

However, around 90,000 pregnant women have been vaccinated mainly with mRNA vaccines, such as Pfizer and Moderna, with no sign of problems.

The mRNA vaccines are not live virus vaccines, which means that these vaccines do not enter the nucleus and do not alter human DNA.

As a result, they cannot cause any genetic changes. 

Pfizer and Moderna are generally considered safe in pregnancy.

They have been given to around 90,000 pregnant women in the United States and the data have not raised any safety concerns.

There are no reported concerns with the AstraZeneca vaccine in pregnancy.

However, there is less experience in pregnancy with this vaccine compared to the Pfizer and Moderna vaccines.

Are Covid-19 Vaccines Considered Safe on Babies?

New research finds that vaccinated women who breastfeed can pass covid-19 protection to their babies.

The study involved 84 women who received 2 doses of the Pfizer vaccine 21 days apart. 

Samples of breast milk were collected before the first dose and then after 2 weeks (once a week for a total of 6 consecutive weeks).  

2 weeks after the first shot, the level of antibodies have significantly increased.

This spike further increases after the second vaccine dose. 

Only 4 newborns experienced fever and congestion, among which 3 cases were resolved without treatment. 

The results from this study seem promising.

However, there are no available data on the long-term effects of vaccination on the mother, the breastfed baby, and on milk production or excretion. 

Participants in this study are still having blood drawn at regular intervals to determine what protection the antibodies against COVID-19  may provide to the baby, and how long they might last. 

Hopefully we will receive better insights soon!

Meanwhile you can read our article Is the Covid-19 Vaccine Safe while Trying to Conceive for more information about safety concerns and fertility. 

Couples who are having trouble conceiving naturally may be wondering what type of fertility treatment they should undergo. 

When it comes to fertility treatment, there are different procedures to consider including IUI and IVF. Some people are more familiar with the term “IVF” and aren’t aware of the differences between both procedures. 

This article explains in detail how IUI works so that you know what to expect. 

What is IUI

IUI refers to the term intrauterine insemination (also known as Artificial insemination). 

The procedure involves the insertion of washed sperm directly into the female’s uterus around the time of ovulation. 

Male Partner

A fresh semen sample has to be obtained through masturbation after an abstinence of 3-4 days, so that the amount of sperm will be enough for a successful IUI. 

If you are using frozen sperm, then the sample is defrosted on the day of IUI. 

In both cases, sperm is washed with a media to clear out impurities in order to obtain the most viable and more motile sperm, which are more likely to reach an egg and fertilize it. 

The washed sperm is then loaded into a syringe to which a catheter is attached. 

Female Partner

Women should have clear and open fallopian tubes (where sperm meets the egg and fertilization takes place) for the treatment to be effective. 

IUI can be done during the woman’s natural ovulation. 

Ovulation predictor kits (OPK) can be used to determine when the woman is ovulating.

However, women having ovulation problems are given medications to induce ovulation and also to increase the number of their eggs in order to increase chances of fertilization.

The Process 

A speculum is introduced into the woman’s vagina allowing the entrance of the neck of the uterus to be made visible. 

The catheter that has been charged with sperm is introduced high enough to the uterus and sperm is manually injected to swim faster towards the fallopian tubes. 

Placing sperm directly into the uterus shortens the distance that the sperm needs to naturally travel in order to reach their target. 

The procedure is safe and is much less invasive than IVF and cheaper because the woman’s eggs are not extracted from the body, and there is no use of great laboratory equipment or monitoring.

Keep in mind that IUI might also increase a couple’s chance of conceiving twins or multiples, because the woman is given medications to increase her number of eggs.

Reasons To Pursue IUI

IUI may not be the most suitable fertility treatment for a couple but it can be a good starting point for couples facing issues to conceive. 

IUI can be effective for couples meeting one of the following requirements:

• The female patient has at least one clear and open fallopian tube and functional ovaries; otherwise, sperm can’t meet the eggs in the fallopian tube, and fertilization does not occur. 
• The male patient has at least 1 million motile sperm to ascend through the fallopian tubes.
• The female patient has mild endometriosis
•  The male patient has erectile dysfunction (ED) – inability to get or keep an erection firm enough to have sexual intercourse.
• The female is using cryopreserved sperm (frozen sperm) or a sperm donor.
• The couple is not being able to have sexual intercourse during the fertile window due to work or travel. 
• The couple has unexplained infertility; It is generally recommended that couples try three rounds of IUI before moving to IVF.

If you or your partner don’t meet the requirements for IUI, then you might consider IVF.

What About IVF

IVF refers to the term in-vitro fertilization. 

The process involves extracting the eggs from a woman’s body using a needle that goes through her vagina. 

Those eggs are then fertilized with washed fresh sperm or frozen sperm in the lab. 

After the fertilization, the fertilized eggs start dividing into cells to become embryos. 

The embryos are monitored carefully and then the healthiest 1-3 embryos are transferred into the woman’s uterus for implantation to occur.   

IVF is usually recommended for couples facing the following issues:

• Severe male infertility (low sperm count and/or motility)

• Damaged or blocked fallopian tubes

• Impaired ovulation

• Unsuccessful IUI treatment

• Concern about passing on certain genetic disorders to the embryo; in that case, you should do IVF with PGD testing (preimplantation genetic diagnosis) to identify genetic disorders or chromosomal abnormalities in embryos before transfer. 

• Female patient is over 40 years old

Free Consultation

If you want to know more about fertility treatment and your options, feel free to consult with me through email. Send me a message with your name, age, location, number of pregnancy attempts, and your diagnosis (if any). I can review your history and discuss a recommended course of action.