July heralds a new hope for motherhood. Effective next month, Singapore will raise the age limit for elective egg freezing from 35 to 37, giving aspiring mums a little more wiggle room to preserve their fertility. This move follows recent research, indicating a “relatively stable” success rate of egg freezing for females up to 37, and will soon be available to all women, irrespective of their marital or medical status.
True to its name, elective egg freezing (EEF) is a revolutionary procedure designed to preserve and reserve female virility—think a literal time freeze on that daunting “biological clock”. It involves a controlled stimulation of the ovaries and a meticulous retrieval of the eggs, which are then prudently kept in cryogenic tanks for future use. In a candid conversation with Vogue Singapore, Dr Liow Swee Lian expressed his view on the impacts of the new age limit, describing it as “a right step forward” and “an insurance policy of sorts”. The scientific director of Virtus Fertility Centre Singapore also emphasised how this progressive change was an advocate for mature women who envision a future with a family but find themselves temporarily unready.
Below are some of the risks and considerations to bear in mind before taking the leap of faith.
How does the new age limit on egg freezing impact its success rate?
Age is the chief protagonist in the narrative of fertility, and the moral of the story is this—the earlier you freeze your eggs, the better. Specifically, that’s before 37, when the likelihood of having the appropriate hormones to coax the eggs out of the reproductive glands takes a plunge. Consequently, women in their mid to late thirties who elect for egg freezing will often require at least two rounds of ovarian stimulation to achieve an acceptable number of eggs and a success rate of more than 50 per cent for a healthy pregnancy.
This reality also brings forth an elevated risk of side effects stemming from repeated ovarian stimulation cycles. “Thus, it is highly recommended that you consult with your doctor to fully understand the dangers of ovarian stimulation, and design the most effective techniques for limiting them,” advises Dr Liow.
Setting aside bodily ramifications, there also lie psychological and emotional tolls on the horizon, regardless of age. The Ministry of Health has mandated that all EEF patients receive counselling prior to treatment, in order to protect against misinformation or unfounded expectations. For instance, Dr Liow refers to the thorough approach used at Virtus, where patients are counselled beforehand on the limitations of EEF, its invasive nature, potential side effects, health risks, and steep cost.
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On the topic of cost, the approximate investment for a single egg freezing cycle is in a ballpark of $10,000 to $15,000, depending on the fertility clinic and specialist. What the complete package usually entails is an evaluation and clinical consultation with a fertility specialist, followed by ovarian stimulation with medications, egg harvesting, freezing, and lastly, storage. And remember—this procedure may need to be repeated several times to harvest an ideal number of eggs for preservation.
What is the process and preparation like?
When confronted with the scary spectre of the word “surgery”, a looming thought appears: Is it painful? Well, Dr Liow sheds light on two potential pain points. The first is during the ovarian stimulation phase, where patients undergo self-administered hormone injections to stimulate the production of oocytes, or eggs, for around two weeks. While some may experience discomfort, bloating, nausea and changes in mood, one’s personal pain threshold levels may very well account for this.
The second is during the actual egg retrieval procedure, where a long, thin needle is inserted into the ovaries through the vaginal canal while the patient is under deep sedation or general anaesthesia. Here, the most common side effects would include vaginal soreness, abdominal cramping, spotting, and bloating. Fortunately, these side effects are said to subside within a few hours, and patients are generally back to their regular selves within a couple of days.
Additionally, changing certain aspects of one’s lifestyle can greatly prime the quality and output of eggs. “I recommend women to be as healthy as possible during the time of egg freezing and ovarian stimulation,” encourages Dr Liow. That warrants putting out cigarettes, consuming little to no alcohol and caffeine, and where possible, avoiding other exogenous drugs. Other healthy habits like maintaining a healthy weight and eating a balanced diet are also emphatically worthwhile.
IVF warriors of the Fertility Support SG often cite Rebecca Fett’s It Starts with the Egg, in which Fett recommends supplements such as CoQ10, vitamin D, as well as folate-rich foods such as beets, leafy greens and nuts. Importantly, while the the process of egg stimulations takes two weeks, eggs or follicles take around three months to develop and mature, which is why making healthier dietary and lifestyle switches sooner rather than later is thought to boost egg quality.
The earlier, the better
Being early is a theme here; early age, early egg retrieval, and early detection. However, life sometimes has other plans. To make the most out of your shot—literally and figuratively—seek medical advice from your gynae as soon as possible.
If your goal goes beyond egg freezing—that is, the intention to create embryos, it’s recommended that male partners be equally aware about their health and quality of sperm before egg stimulations. This can be done via a fertility screen.
According to Dr Liow, is important to note however, that “EEF does not always guarantee a healthy live birth” with many factors at play. Ever optimistic, we can’t help but think that the option of EEF for all Singaporean women age 37 and below is a positive first step.
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