Dr Sulbha Arora, clinical director and fertility specialist at Nova IVF Fertility, explains everything you need to know about freezing eggs in India -- the process, the cost and the risks involved.
Over the past few years, egg freezing has gradually shifted from a lesser-known fertility procedure to a widely discussed trend, especially among urban, career-oriented women in India.
What was once considered a medical necessity is now being viewed as a proactive choice.
One of the earliest and most vocal Indian celebrities to openly discuss egg freezing is former Miss World Diana Hayden, who reportedly froze her eggs and later gave birth using those eggs.
Speaking at a recent event, Upasana Konidela revealed that she froze her eggs at the age of 29; she recommended it, describing it as 'the best insurance a woman can have for herself'.
Dr Sulbha Arora, clinical director and fertility specialist at Nova IVF Fertility, explains everything you need to know about egg freezing in India -- the process, the cost and the risks involved.
What is egg freezing?
Women have a finite number of eggs and, as they age, the quantity and quality of eggs decline.
Around the mid-30s, this decline becomes more rapid. Egg freezing is an option available to women who wish to preserve their fertility for the future by freezing their eggs.
It is mostly used as insurance; if they cannot conceive naturally in the future when they start planning a family, they can come back and use the frozen eggs, thus helping them plan parenthood at their own pace.
The frozen eggs are then thawed and fertilised through an ART (assisted reproductive technique) procedure called ICSI (intracytoplasmic sperm injection).
We have observed two primary reasons why women consider freezing their eggs.
One reason is medical where women suffering from conditions such as cancer require chemotherapy or radiotherapy as part of their treatment. Since such therapy will damage their ovarian reserve, they can opt to freeze their eggs before starting their cancer treatment, enabling them to have a chance at conceiving their own biological child in the future.
Other medical conditions, such as endometriosis, can also cause severe deterioration of the ovarian reserve; women suffering from it benefit from egg freezing they are not immediately planning a family.
The second reason is social.
Egg freezing offers women the freedom over their life's choices so they can plan a family when they are ready for it.
While it does not reduce the chances of them conceiving naturally in the future, it works as a safeguard in case they reach a stage where natural conception is no longer possible due to a depleted ovarian reserve.
In these cases, it is considered to be an insurance for the future.
Is there a maximum age limit for egg freezing?
While there is no age limit for freezing eggs, it is important to note that the quantity and quality of eggs decline as a woman ages. The ideal age to freeze one's eggs is in the late 20s or early 30s.
Success rates with the frozen eggs in future depend on the age at which they were frozen. Younger eggs have a better chance of developing into a healthy baby.
We usually don't recommend that women in their 40s undergo this process; however, everyone's ovarian reserve differs and older women wishing to opt for it can consult their fertility specialists to know if it would be worthwhile in their case.
How can someone freeze their eggs? Understanding the process, step by step...
Each month, the body naturally selects a crop of eggs from which one egg usually ovulates; the rest are discarded by the body.
To undergo egg freezing, the woman is given gonadotropin injections from day 1 or 2 of her cycle for about 10 to 11 days to ensure that multiple eggs from that crop grow instead of just one.
During this phase, she is called to the clinic four to give times for ultrasound monitoring of the ovarian response.
Once the eggs reach a ready size, they are aspirated under short general anaesthesia by a needle-aspiration process that takes about five to 10 minutes.
After they are retrieved, the eggs are scanned to check how many of them are mature.
The mature eggs are frozen using a vitrification technique and kept stored in liquid nitrogen until the need to use them arises.
As this procedure only gently picks up a crop of eggs the body would have anyway discarded, it does not make the reserve decline faster or empty the ovaries.
What is the cost of freezing eggs in India?
Egg freezing expenses in India are often between Rs 1.5 and Rs 2.5 lakhs, inclusive of the process and medication or injections used plus freezing and storage costs.
The reason for the price variation is the drug dose; not everyone requires the same doses or types of injections and the cost depends on that.
Some corporate offices also cover egg freezing as part of employee wellness benefits.
It is important to choose a clinic that is transparent in terms of success rates of the treatment, offers you emotional counselling facilities, clearly explains the costs beforehand with no hidden charges and provides detailed documentation.
How long can you freeze your eggs?
According to the Assisted Reproductive Technology (Regulation) Act in India, the storage of frozen eggs is limited to a period of 10 years.
The woman must provide her consent for each year of storage.
While 10 years is the standard limit, extensions are possible in special situations, such as for cancer patients, provided the required approvals are obtained.
The ART (Regulation) Act, 2021, allows women to undergo assisted reproductive techniques until the age of 50 for the wife and 55 for the husband; beyond that age limit, they may no longer be permitted to use their own previously frozen eggs and may need to discard them if still unused.
How does egg freezing help in IVF?
In IVF, a healthy embryo is the heart of a fertility treatment.
If the embryo needs to be healthy, the gametes, ie the eggs and sperm, also should be of good quality. Hence, if the eggs are frozen when the reserve and quality are good, even if the couple faces infertility issues later on, the frozen eggs and the husband's sperm can be used to create an embryo.
It takes two to tango; hence, although the woman has frozen her eggs, the husband's sperm also matters equally. Not all women who freeze their eggs go for IVF compulsorily; some can also conceive naturally.
Does egg freezing also help if you have an older partner?
Male fertility also declines with age, although to a lesser extent than female fertility.
An embryo is the result of an egg and a sperm; when both gametes are healthy, it increases the chances of a successful pregnancy.
Can you freeze eggs after your first pregnancy?
Yes. Having had a previous pregnancy does not affect your ability to freeze eggs.
Many women freeze eggs after their first child to preserve options for spacing children or for future family planning.
Your ovarian reserve will still be evaluated before the cycle. The process is the same as it would be for someone who has not been pregnant. Past pregnancy does not guarantee present egg quantity or quality.
What are the basic tests or requirements to freeze eggs?
An ultrasound is done to assess the antral follicle count in the ovaries.
Blood tests include the serum AMH (anti mullerian hormone), which is another marker of ovarian reserve, and hormone tests such as TSH and prolactin, infectious disease screen (for example, HIV, Hepatitis B & C) and some general health tests.
Do you need your parents' consent to freeze your eggs?
Egg freezing is a personal medical and reproductive decision.
In India, the ART (Regulation) Act, 2021 says that the minimum age to undergo any ART procedure is 21 years.
Having said that, ethical fertility specialists will advise you to freeze your eggs only if there is a need and not push you for it.
Parents' consent is not needed to freeze your eggs if you are 21 for ART procedures.
Your decision remains private and confidential.
If egg freezing is required for medical reasons, such as cancer, it can be done for girls younger than 21, too, and will need parental consent.
Can egg freezing guarantee a future pregnancy?
Freezing eggs does increase the likelihood of conceiving later in life but it does not provide absolute certainty that you will have a child.
Some eggs may not survive the thawing process; others may not fertilise or develop into viable embryos.
Ultimately, the treatment's outcome depend on a variety of factors like the age at which you freeze your eggs, the number of eggs you have frozen as well as the quality of sperm used for fertilisation.
Uterine and general health factors also impact the chances of conceiving. Therefore, although the frozen egg is an additional tool to help improve your chances of success with fertility treatment, it cannot be considered a guarantee of pregnancy.
It is extremely crucial to counsel the woman about the success rate and be transparent about it. There are some women who, despite freezing their eggs, may not need to use them as they would have conceived naturally.
On the other hand, there are cases where women have come back to use their frozen eggs and conceived.
Fertility treatments can never be 100 per cent successful; there are limitations associated with it. However, they do increase the chances of conceiving when natural conception fails.
Is egg freezing painful?
The hormonal injections are given by the subcutaneous route using thin needles and usually do not cause pain.
The egg pick-up itself is a minor needle aspiration procedure done under short general anaesthesia so the woman is asleep during the procedure.
Post the procedure, some women may experience pelvic discomfort or mild cramping for a day or so but pain is uncommon.
The overall level of discomfort endured by women during this entire process is typically mild and manageable for the majority of women.
What are the risks or side effects associated with egg freezing?
Overall, egg freezing is a safe and gentle procedure; however, everyone's body reacts differently.
Some women may experience bloating, headaches, mood swings or cramping caused by the hormones used to stimulate the production of eggs.
These side effects are transient and typically reduce or disappear after the egg retrieval.
One rare but serious side effect is ovarian hyperstimulation syndrome (OHSS), which can cause a woman to produce more eggs than predicted and lead to severe abdominal pain and bloating among other symptoms. However, OHSS is almost a thing of the past now, as these days fertility specialists are extremely precise with their injection doses and use gentle, more patient-friendly protocols with minimal doses.
This is another reason it becomes important to choose the right clinic and an experienced fertility specialist.
How do hormone injections used before retrieving eggs affect women?
The hormone injections, also called gonadotropins, contain the hormones FSH (follicle stimulating hormone) and LH (luteinizing hormone), which are naturally produced by the human body to stimulate the growth of an egg each month. Thus, these injections do not contain anything artificial or harmful.
They temporarily stimulate the ovaries to grow multiple mature eggs instead of just one.
Some women may experience very mild side effects of hormone injections such as breast tenderness, bloating and emotional changes. Most women are quite comfortable during the stimulation.
Can you work normally during the egg-freezing cycle?
Yes, most people continue working as usual. Hormone injections take only a few minutes at home.
You will need a few (usually four to five) short clinic visits for ultrasound monitoring.
Toward the end of the cycle, bloating or discomfort may make strenuous activity difficult in the last couple of days.
On the day of retrieval, women are advised to take the day off from work as the procedure is done under anaesthesia.
Most women are return to work and routine activities the very next day or, at the most, after one additional day post retrieval.
Some corporate organisations support their employees during this journey by providing options like work from home for the days when full activity levels are not possible.
Can you donate eggs instead of freezing them for yourself?
You can opt to donate your eggs altruistically if you wish; however, you have to follow the procedure laid down by the ART Act.
A donor needs to register with an ART Bank as an egg donor. She must be between 23 and 35 years of age and undergo mandatory medical and psychological screening.
A donor can donate eggs only once in her lifetime and only for a particular couple.
Also, the Act clearly says that egg donation is taken care of by the ART banks and not by fertility clinics directly.
The fertility clinics are only involved in performing the clinical procedure. Hence, this comes under the purview of ART Banks.
What legal rights do you have over your frozen eggs?
As the owner of your frozen eggs, you are the one who decides when those eggs will be used, stored, donated or discarded.
Written consent is required from you and most clinics require that consent forms be updated periodically.
What happens if you do not use your frozen eggs?
You can choose to keep them stored or discard them. Consent is taken at every stage of the procedure.
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