Social Egg Freezing

Micro dissection Testicular Sperm Extraction (micro-TESE) is a refined version of TESE. Instead of removing a random sample of testicular tissue, a skilled surgeon uses an operating microscope to precisely identify areas of the testicles more likely to contain sperm. This allows for a more targeted and minimally invasive approach to sperm retrieval, reducing the risk of damage to the testicular tissue and increasing the chances of finding viable sperm. Micro-TESE is particularly beneficial for men with non-obstructive azoospermia, where sperm production is impaired or absent.

Which patients used MicroTESE

Non-Obstructive Azoospermia (NOA) patients who’s suffering male infertility which can be resolved by retrieval of testicular sperm to be used for ICSI. Micro TESE procedure should be performed to see if a viable sperm can be found in the testis.

How is the procedure carried out?

The testis is cut to obtain a tissue sample. It is a short-term procedure and generally does not require hospitalization after the procedure. There are high sperm retrieval rates with a microTESE (50-55%), except in some cases where large fragmentations (Y microdeletions) and sertoli cell only occur, in some Y chromosomes where sperm production is not or seriously affected. In cases where there is extensive testicular damage, such as in severe cases of Y chromosome micro deletions or Sertoli cell-only syndrome, Micro-TESE may not be able to locate viable sperm. Micro-TESE is methods that sperms are directly retrieved from the testicular germinal epithelium. Tissue samples that are taken from the outer testicular layer by small incisions are referred to the embryology laboratory. The fresh sperm that is retrieved are immediately used for oocyte fertilization with ICSI method at the same day of oocyte retrieval in an IVF cycle.

What are the advantages of Micro TESE procedure?

• Higher success rates in non obstructive azoospermia (NOA): micro-TESE generally has higher success in extracting sperm; as such, micro-TESE is preferable in cases of NOA, where infertility is caused by a lack of sperm production rather than a blockage.
• Larger number of sperm retrieved: Micro-TESE method obtains much more and better quality sperm compared to the previous multiple biopsy method. Relatively higher chance of sperm freezing.

What are the disadvantages of micro-TESE procedure?

• The procedure is more invasive than classical TESE, requiring general anesthetic, and generally used only in patients with non-obstructive azoospermia. The cost of micro-TESE is higher than TESE procedure.
• Operation time is longer.

Social egg freezing, also called elective egg freezing, is a procedure in which eggs (oocytes) are retrieved from a woman, frozen, and stored for future use. This allows women to preserve their fertility and plan pregnancy at a later stage when they feel ready.

Women may opt for egg freezing for various personal reasons, including:

• Postponing motherhood: Some women delay starting a family due to career ambitions, studies, financial stability, or the absence of a suitable partner.
• Genetic factors: Women with a family history of early menopause or fertility issues may choose to preserve their eggs early.
• Certain diseases like Endometriosis and autoimmune disorders decline your ovarian reserve.
• Lifestyle choices: Women who wish to have reproductive flexibility later in life.

The Egg Freezing Process-

• 1. Initial Consultation: A fertility specialist evaluates ovarian reserve through blood tests and ultrasound.
• 2. Ovarian Stimulation: Hormone injections are given for 10–14 days to stimulate the ovaries to produce multiple eggs.
• 3. Egg Retrieval: Mature eggs are collected through a minor surgical procedure under sedation.
• 4. Freezing (Vitrification): The eggs are frozen using a rapid freezing technique called vitrification.
• 5. Storage: The frozen eggs are stored in specialized fertility labs until they are needed.
• 6. When a woman decides to use her eggs, they are thawed, fertilised via IVF (In Vitro Fertilization), and transferred to the uterus.

Success Rates and Considerations

• Egg freezing does not guarantee a successful pregnancy in future.
• The success of egg freezing depends largely on the woman’s age at the time of freezing. Eggs collected from women at a younger ( before age 35) have a higher chance of leading to a successful pregnancy.
• Freezing 15–20 eggs is generally recommended to maximise future pregnancy chances.
• Worldwide studies have come out with various parameters regarding social egg freezing

Mean age at freezing	37.3 years
Usage rate	12%
Thaw/survival rate per oocyte frozen	82%
Fertilisation rate per injected oocyte	67%
Live birth rate per ET	35%
Less than 38 years >38 years	48% 21%

While egg freezing is a well-established procedure, it carries some risks:

• Ovarian Hyperstimulation Syndrome (OHSS): A condition that may occur due to excessive response to hormone stimulation, causing bloating, discomfort, and, in severe cases, fluid accumulation.
• Surgical risks: The egg retrieval procedure carries minor risks such as bleeding, infection, or reactions to anaesthesia.
• Emotional and psychological factors: Women may experience anxiety over whether they will conceive in the future, even with frozen eggs.

Considerations About Pregnancy at an Older Age

Although social egg freezing helps preserve egg quality, it does not eliminate risks associated with pregnancy at an older age. Some important factors to consider:

• Declining uterine receptivity: While eggs remain frozen at their original quality, the uterus also ages, which may impact implantation success and pregnancy health.
• Increased pregnancy complications: Older women are at higher risk for gestational diabetes, hypertension, and preterm birth.
• Higher risk of C-section: The likelihood of needing a C-section increases with maternal age.
• Increased risk of chromosomal abnormalities: While younger eggs reduce some risks, pregnancy at an advanced maternal age may still have higher chances of complications.

Costs and Emotional Considerations

• The cost of egg freezing varies by country and clinic, often including medication, retrieval, and storage fees. Some employers offer coverage as part of fertility benefits.
• The decision to freeze eggs can be emotional. Women should consider both the psychological and financial aspects before proceeding.
• It is important to understand that freezing eggs does not guarantee a successful pregnancy in the future. Therefore, it is crucial to plan fertility preservation realistically.

By being well-informed about the benefits and limitations of social egg freezing, women can make empowered decisions about their reproductive future.