Egg freezing can be a fertility preservation solution in the following cases:

• For social or professional reasons, such as women without a partner or without a stable relationship or women who choose to prioritize their careers.
  The tendency to delay childbearing in modern societies has been accompanied by difficulties in conceiving. Older age is associated with a significant decrease in fertility, due to a decrease in the total number and quality of eggs. Factors that could lead to a delay in the first pregnancy include: lifestyle, educational opportunities, career choices etc. (Chen and Morgan, 1991 Gustafsson, 2001). Facebook and Apple's announcements that they would provide a bonus to cover the costs of egg freezing for their female employees, as well as media coverage of this issue led to an increase of public awareness regarding egg freezing, first in Canada and America and then around the world.

• Before chemotherapy - radiotherapy.
  Most of these treatments are likely to damage the egg supply (ovarian reserves) on a temporary or permanent basis, thus leading to partial or total ovarian failure. The result of ovarian failure is, initially, menstrual disorders, with the last stop being menopause. The medical plan varies depending on the age of the patient, the type of malignancy, as well as the general treatment protocol.
• Due to threatened premature ovarian failure (POF).
  Some forms of POF are hereditary. Egg freezing offers a unique opportunity for these women to preserve their fertility before their ovarian reserves are depleted.
  
  
• In cases where no sperm are found in the initial semen sample after sperm collection or after a biopsy of the partner's testicle on the day of ovulation.

The eggs that are frozen preserve the chronological age of the woman on the day of freezing. Therefore, it is important to freeze your eggs at as a young age as possible. The ideal age for a woman to undergo egg freezing is between 25-36 years old. However, even older ages cannot proceed with this procedure, but according to research, the younger the woman is, the better the quality and the number of eggs and the greater the chances of a future pregnancy.

Egg freezing is carried out as part of an IVF cycle with medication for controlled ovarian stimulation. Stimulation of the ovaries is necessary in order to retrieve as many eggs as possible at egg retrieval, just like in a typical IVF cycle. The only difference is that, after egg retrieval, there is no fertilization of the eggs by the sperm, no embryo transfer, but egg freezing. Alternatively, the procedure can be carried out in a natural or modified natural cycle (Modified Natural Cycle, MNC) which has the advantage of minimal to no use of drugs.

At Eugonia IVF, following the global scientific developments, we use:

Patient - friendly stimulation protocols of:

• shorter duration
• fewer injections
• lower total drug dose
• fewer side effects and complications
• less discomfort

The entire procedure includes ultrasounds and blood sampling (blood tests) every 2-3 days, which does not disrupt everyday life, while, after ovulation, women can immediately return to their daily routine.

Special medication for the final maturation of the eggs that ensures:

• higher percentage of mature eggs
• less discomfort
• increased safety with complete elimination of the Ovarian Hyperstimulation Syndrome (OHSS)

Oocyte collection is performed via transvaginal ultrasound-guided oocyte retrieval under sedation and lasts roughly 20 minutes. The result is one almost pain free experience. After the procedure you may feel slight cramping or even a little pain.

Egg freezing has for many years remained a challenge for the field of assisted reproduction, as the low survival and low fertilization of eggs using older techniques resulted in low pregnancy rates.

With the application of vitrification, egg freezing is accompanied by high rates of survival, fertilization, embryo quality, blastocyst formation, which of course also result in higher pregnancy rates.

According to the current literature, the health of children born from frozen and fresh eggs appears to be similar, as well as complications during pregnancy. Regarding the safety of women receiving hormonal stimulation, according to large epidemiological studies and ASRM (American Society for Reproductive Medicine) guidelines, although data regarding the association of drug use and cancer incidence are limited, the use of these drugs does not appear to increase the risk of ovarian, endometrial and breast cancer (Fertility drugs and cancer: a guideline Practice Committee of the American Society for Reproductive Medicine, Dec 2016). However, the pharmaceutical preparations (hormones) should be administered in the smallest possible doses according to the current trends in the field of reproductive endocrinology as formulated in the recent guidelines of the European Society of Human Reproduction and Embryology (ESHRE) (Guideline of Ovarian Stimulation for IVF/ICSI , ESHRE Reproductive Endocrinology Guideline Group, October 2019).

Oocyte cryopreservation does not affect the chances of natural conception in the future. Also, it does not affect your ovarian reserve.

The whole process takes 8-10 days and includes ultrasounds and blood tests every 2-3 days. Following egg retrieval, which takes approximately 15 to 30 minutes and performed under sedation, patients can return to their daily routine even on the same day.

At Eugonia special medication is used for the final maturation of the eggs which ensures a greater percentage of mature eggs, less discomfort and increased safety with the elimination of the ovarian hyperstimulation syndrome (OHSS).

With the vitrification method, the eggs are exposed to special cryoprotectant solutions and then placed directly in liquid nitrogen for storage. In this way, the inside of the cells acquires a glass-like structure (vitrification) and formation of crystals, which would have disastrous consequences for their viability, is prevented. With the development of vitrification, egg freezing is accompanied by high rates of survival, fertilization, embryo quality and, as a result, higher pregnancy rates.

At Eugonia, following global scientific developments, we implement a successful egg freezing program, for both social and medical reasons, responsibly advising patients on the benefits as well as the caveats that that the process entails.

The equipment of the Eugonia’s Cryopreservation Bank includes, among other things, automatic monitoring of the temperature and liquid nitrogen levels within the storage dewars, security systems that operate on a 24/7 basis, fire protection systems and alarm notification from a signal receiving center.

It is now internationally accepted that success rates in IVF depend on, both the number of eggs retrieved and age. The studies proving this have been carried out in a large number of patients reaching 400,135 (Sunkara et al., 2011, HFEA data). Data relating to the association of age with success rates come from the Australian and New Zealand Assisted Reproduction Database (ANZARD - Law et al., 2019). A frequently asked question in clinical practice relates to the number of cryopreserved oocytes sufficient to achieve pregnancy.

In order to predict the probability of a woman giving birth to at least one child (live birth) without being arbitrary, in Eugonia we present Goldman's study (Goldman et al., 2017).

The probability of achieving at least 1 live birth per age and number of mature oocytes. Each curve corresponds to the probability of a woman of a certain age achieving at least a live birth based on the number of mature oocytes collected and cryopreserved (Goldman et al., Human Reproduction 2017)

This specific study provides us with a statistical model (evidence-based model) based on the age of the woman at ovulation and the number of mature eggs (that can be fertilised) that will be frozen. This statistical model (evidence-based model) also answers the second most frequent question which is whether repeating the procedure (additional cycles of stimulation) would significantly increase the chances of live birth.

According to the Greek Legislation, the duration of cryopreservation is 5 years, with the possibility of extension for 5 years each time upon written request, without an upper limit of extension. Fertility preservation is achieved by cryopreservation of eggs at -196°C, thus preserving the woman's biological age at the exact moment of freezing. Eugonia’s Cryopreservation Bank, is licensed by the National Authority for Medically Assisted Reproduction (Government Gazette 3959B/0-11-2017), meeting all international technology, quality and safety standards.

Many women wonder if this method is safe for the children to be born and if the medication administered are associated with malignancies and more specifically with breast cancer. Based on studies carried out worldwide, it is considered completely safe:

• To date, approximately 6000 babies have been born from frozen eggs. The largest published study of over 900 babies from frozen eggs showed neither increased rate of birth defects compared to the general population, nor increased rates of chromosomal abnormalities compared to embryos from fresh eggs. In 2014 a new study showed that complications during pregnancy after egg freezing did not increase. There have also been over 300,000 children born worldwide from frozen embryos, mostly using cryopreservation techniques, with no increase in birth defects.
  
  
• According to large epidemiological studies of hundreds of thousands of hormone-treated women who underwent an IVF program and women who did not receive hormones, no difference in the incidence of breast cancer was observed. The hormones should be administered in the smallest possible doses and for the shortest possible duration, as advocated by modern trends in the field of reproductive endocrinology.

The total cost including stimulation, oocyte retrieval and oocyte cryopreservation is lower than that of an IVF cycle because it does not include oocyte fertilization and embryo transfer. However, the cost of ovarian stimulation medication should also be taken into consideration. A low-cost annual storage fee of approximately 200 euros is also paid to the IVF Unit, while cost-efficient solutions are provided for 3-year, 5-year and 10-year storage periods.