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How the technology has changed

Alpesh Doshi
Egg freezing offers women a chance to preserve their fertility. And this is not only offered to women who want to preserve their fertility for medicinal reasons such as undergoing some form of cancer therapy. But also offers women the option to preserve the fertility for social reasons. So egg freezing has evolved as a technology in this last 10 years because of the optimized success rates. Egg freezing has been performed in the UK since the 1990’s, however, the technique has evolved a lot since then to the present times. And the main developments in this arena have been in the laboratory. The reason for that is the revised or the optimized technology of vitrification, which is now being applied to freezing of eggs.
Traditionally in the olden days the methodology revolved around slow freezing of human eggs. With the new technology, which enables further dehydration of the egg leading to less water retention in the egg, which then means that there is less intracellular ice crystals, which lead to the damage of the egg per say. So all in all further dehydration, faster freezing enables the technique of vitrification, which enables better survival. The success rates have changed in many ways. The survival rate of the eggs is much better with vitrification. We obtain in excess of 80 to 85% survival rates of the eggs. In the olden days we used to get around 50% survival rates.
Survival rate is one aspect or a measure that looks at success. However, the bigger measure is the chance of having a baby. And in the olden days again, with slow freezing as a technology the pregnancy rate per egg was very minimal. Now days we are quoting a pregnancy rate of around 60% in women under the age of 35, should they have at least 8 to 10 eggs frozen. Technology has evolved a lot in this last ten years in itself. So I know for a fact that scientists who have developed vitrification as a tool are working towards optimizing the technology further.
We are pretty much at the pinnacle of success rate when it comes to cryobiology or freezing technology So we may get better by a few percent, which would be great. It would be amazing to take survival rates of eggs to around 90 to 95% and I think certainly that in this next 5 years we may see this increment in success rates. I think the future of IVF revolves around optimum freezing technology. And the fact that now days we are almost performing over half the number of IVF cycles that we do with the aid of egg or embryo freezing, suggests that this technology works very well when applied to patients.
A lot of patients when they are having controlled ovarian hyper-stimulation to make them produce quite a few eggs, which is part and parcel of IVF, they prefer to break the cycle by freezing their eggs and then coming back for an embryo transfer at a later date. This gives their body an ability to recover from all the hormonal stimulation and at the same time they are more relaxed because the whole process can be broken down into two parts. Being an embryologists, which is a very new and dynamic profession, and to be honest, embryology as a profession has attained quite a lot of recognition in this last 10 years.
We used to be considered the scientists behind the scenes who are pretty much in the dark performing the embryology and now days it has attained a lot of patient liaison, patient contact etc. So to me embryology is very fascinating. It is very exciting. And to a certain degree it gives me a lot of job satisfaction because I know that I can try and make a change in someone’s life. When couples come to an IVF clinic they expect a lot of sympathy, they expect a lot of professionalism, and working with patients, together with patients, to give them optimized care whether it leads to success or not is a very fulfilling part of my role. I trained at CRGH.
I have been at CRGH for 17 years now. So it has been a long time. And I have seen the unit grow leaps and bounds. We used to perform 170 cycles in 1998 and we are touching almost 1,500 to 1,600 cycles a year now. So CRGH has grown a lot and we have grown with CRGH. Ideally the chances of pregnancy in any woman is based on 2 factors. One is her age and the other one is her ovarian reserve. This is classically the test that they perform clinically to assess a patient’s potential to produce eggs when given stimulation. During the process of stimulation the drugs that are given to her makes the woman’s ovaries produce more and more eggs.
So in terms of the success rates, the success rates are determined on if the patient is young, A, and B, if she has a good ovarian reserve. If the patient is older, obviously, the quality of the eggs can be questioned because of the chromosomal abnormalities within the eggs. So it is not so much the survival of the eggs that is questioned during egg freezing but it is more the potential of the eggs after they have been defrosted. We cannot change the make-up of the egg. We can only preserve it. So the chances of any woman conceiving is based on the predisposing factors, which is her age and her ovarian reserve.

In this video, we meet Mr Alpesh Doshi, UCL lecturer and senior embryologist at The Centre for Reproductive and Genetic Health. Alpesh has been involved in IVF for almost two decades and he has seen how the field has changed, driven by scientific advances, especially in embryology.

In this interview, he discusses egg freezing from a technical point of view, how the technology of egg freezing has changed and also the importance of tailoring treatment to each individual. He describes the impact of the new technologies and how it has changed the expectations of both clinicians and clients.

For discussion: Statistics for successful pregnancies vary depending on the methods used and the skills available. The CRGH achieves up to a 60 per cent pregnancy rate from their frozen eggs. However, that is only for women below the age of 35 should they have at least 8-10 eggs frozen.

What do you think about this pregnancy rate statistic?

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