Freeze All IVF Cycles: Is it the right choice?

Freeze all IVF cycles are becoming more and more common. In the US 25% of IVF cycles are elective freeze all options.

With it becoming more and more common with celebs such as Rebel Wilson, Rita Ora and Olivia Munn to name but a few who have chosen to freeze their eggs for future use. Also, Facebook and Apple now offer heavily discounted egg freezing as a company perk.

It is clear that this is an elective IVF treatment add-on whose growth isn’t slowing down any time soon.

In the UK we’re not quite at the numbers seen in the states, but what is for sure is that this option is growing in popularity at a rapid rate. In 2010 there were just over 200 freeze all cycles and by 2016 this was just under 1200 this is nearly a 6-fold increase. With an increase of over 10% between 2015 and 2016. We don’t have more recent data than that as the HFEA releases UK statistics every 3-5 years.

So why is it becoming more popular and what is it?

What is an elective freeze all IVF cycle?

In a nut shell it is a normal IVF process which doesn’t have the implantation of a fresh embryo, all the eggs are frozen before fertilisation.

So, the woman goes through the down regulation, the stimulation phases of IVF then has her eggs collected. These eggs are then frozen using a process known as oocyte (a technical term for eggs) cryopreservation.

A quick overview of this, is that the eggs are prepared in a substance called a cryoprotectant which replaces all the water in the egg which in turn protects them from the extreme cold temperature. The are then cooled to around -196 centigrade using liquid nitrogen.

There are 2 methods of freezing, the slow method which is now less commonplace, and the fast method known as vitrification. This rapid cooling method reduces the formation of ice crystals in the egg which can damage it; which is why it’s now the preferred method of freezing eggs.

These can then be stored for up to 10 years.

Why would you consider freezing your eggs or embryos?

As far as we can tell from research and having spoken to many women considering this there are 4 main reasons for having an elective freeze all IVF cycle which are:

#1 – Reduction in Fertility

This is something that we have talked a lot about on this site, but the simple answer is this. As a whole the age that people are starting to try to conceive is getting older. People are marrying or meeting their partner they want to start a family with later, careers are more important to people which means they are focusing on those for the early parts of their lives.

All of these things mean that many people aren’t thinking about children until their mid-30’s. Although when this is coupled with greater knowledge which has come with decades of research into fertility it is now clear that fertility rapidly declines with age.

For instance, did you know that you about 11,000 eggs die per month from a woman’s reserve.

Hence many women who are not ready to have children yet are choosing to freeze their eggs.

#2 – Illness or hereditary problems

Very sadly, some people get some serious illnesses such as cancers, where the treatment is highly likely to seriously affect their fertility and, in some cases, make them completely infertile.

These women often choose to have their eggs frozen before treatment so that in the future they still have a chance of having a biological child. This is a balance, because some treatments are time sensitive and having your eggs frozen takes time, but your specialist will discuss this with you.

#3 – Not met that right person yet

This one was reported in 88% of cases from a recent article by extend fertility (link to their website) Which makes sense, as we mentioned at the beginning of the article many people are starting relationships later in life.

There is no longer a societal expectation that people are married by 21 and to be single way into your 30’s and 40’s is common. But this change in the way we are developing relationships hasn’t stopped people wanting children, as such the technology we have now, allows people to focus on what is important to them at the right time for them!

#4 – To reduce the risks associated with OHSS (Ovarian Hyperstimulation syndrome)

You can read our detailed guide on OHSS to get a full understanding of the condition. OHSS can become much worse and last for much longer if the women becomes pregnant. In mild to low level sever OHSS it has no additional risks that we know of to you baby. But it can have serious impacts on the mother.

As OHSS is only caused by the stimulation of the ovaries and follicles during IVF and if you don’t get pregnant this normally only lasts a few weeks. By having your eggs frozen then the risk of having the time you suffer with OHSS is reduced.

How successful are Freeze all Cycles?

The success rates for freeze all cycles doesn’t yet have a conclusive answer. However, a Cochrane review of 4 studies showed that there no statistical difference between frozen and fresh transfers and a 2017 study showed a 32% increase in ongoing pregnancy rates – However this is a very small selection of 3 studies.

Having read 10 of the latest studies and trials it appears that frozen transfers are likely to be slightly more effective than fresh transfers. A large scale study is being performed at the moment whose results could answer this question more conclusively called E-Freeze (link to the study website)

How much do Elective Freeze all IVF Cycles Cost?

This is one of the downsides of the egg freezing option. The total process may cost you substantially more than a standard IVF process.

The average cost in the UK for a freeze all cycle is £4,293 for the initial IVF cycle and the freezing of the eggs for a year. Then an additional £378 per annum freezing and storage charge then £1,448 pounds per transfer.

So if you had a freeze all cycle kept your eggs for 7 years and required 2.2 transfers (the average per live pregnancy as deemed by the NHS over the whole population) it would cost you £10,124 and this assumes a normal response with enough eggs to freeze for multiple transfer attempts.

The costs would be much higher if you needed to use donor sperm.

In the states this option costs just under $24,000. If you’re interested in how we got the average cost check out our awesome guide to IVF costs in the UK where we spent 50 hours researching.

As a final point in the UK freeze all cycles aren’t available with NHS funding unless you are diagnosed with a condition which will impact your fertility.

What about the risks of Freeze all IVF Cycles?

As with any medical procedure and medications there are risks. The main risk is from the stimulation phase of IVF which can cause a condition called OHSS which comes in different severities.

The second risk is in your response to stimulation, it is possible that you may only get a few eggs or in a worst-case scenario you get no eggs to freeze. Sadly, if this is the case then your only option is to try again at full cost with a slightly more aggressive stimulation protocol which would increase your risks of developing OHSS.

The final risk specific to freeze all is that the freeze and thaw process can damage your eggs and make them un-usable in transfer. It is also evidenced that embryos survive slightly better than eggs through the cryopreservation process

Finally, there is actually a benefit to freeze all cycles from a risk standpoint. If you do develop OHSS it’s likely to be less severe and not last more than a few weeks. Whereas in a fresh transfer patient that develops OHSS and does become pregnant, OHSS can become more serious and last a long time, in some cases all the way throughout pregnancy.

Should I have an Elective Freeze All IVF cycle?

Now that you have read all the above you are in a strong position to decide if it could be the right option for you.

As it’s not available on the NHS you have to be able to afford it. But with the initial costs being around £4,300 this isn’t completely prohibitive, as you would then have time to save for the transfer element of the process over time.

The HFEA rate this IVF treatment add-on amber which means that the evidence isn’t quite there to support it. They have this to say about freeze all IVF cycles

“Research into freeze all cycles is progressing quickly. Some research suggests that pregnancy rates are increased by using frozen embryo transfers (FETs) rather than fresh transfers, and that the risks to mother and baby are lower. These include the risk of OHSS (above) and of low birthweight.

However, at the moment, doctors don’t know with enough confidence whether freeze all cycles are safer and more effective than conventional IVF or ICSI”

Our opinion is that this is the absolute best IVF add-on option for those that think that the cost is acceptable to give them the peace of mind that comes with knowing that if their ovarian reserve is low at the time they want to have children then they still have this option available to them.

We feel that the cost is fair, although still very high like all IVF treatments and the process itself presents benefits which you wouldn’t have from a regular IVF process.

The only area that I wouldn’t recommend it for is if you think you’ll have a better chance at conceiving by freezing your embryo’s instead of implanting them fresh, because the evidence either way just isn’t conclusive yet.

As a final point this is an IVF treatment add-on that I would recommend to any-one who wants children but not till they are older, who wants to focus on their careers or who are in their 30’s and haven’t found their partner yet or may want to use donor sperm in the future.

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