Elective Egg Freezing In Singapore: All You Need To Know

If you are in the process of undergoing an elective egg freezing (EEF), you may be experiencing a whirlwind of emotions.

You might feel a mix of hope and anxiety because of the possibilities it brings regarding securing your fertility while also grappling with the uncertainties. There may be moments of sadness, as it can be a reminder of some of the challenges you have faced in trying to achieve your fertility goals. You may also feel relieved, knowing that you are taking proactive steps to preserve your fertility.

On top of that, elective egg freezing can feel both daunting and liberating at the same time.
On one side, it offers a glimpse into the possibility of becoming pregnant later or growing your family. On the flip side, you have to consider the costs, success rates, and potential side effects associated with the procedure.

But, you are not alone.

To prepare for the procedure, it is crucial to understand the different aspects of elective egg freezing (EEF). Keep reading to learn more about the steps to take before the EEF process and what to expect during and after the procedure.

What is Elective Egg Freezing?

Elective egg freezing, also known as oocyte cryopreservation, is a procedure offered to women who want to increase their chances of getting pregnant at a later age.

It involves ovarian stimulation with hormonal injections followed by a minor procedure for egg retrieval, after which the eggs are frozen with liquid nitrogen and then stored for future use.

Elective egg freezing in Singapore was implemented in July 2023. A recent review resulted in the age limit being raised from 35 years to 37 years. This means if you live in Singapore, you have more time to think about elective egg freezing. Either way, it’s a good idea to get your fertility testing done early and regularly to understand your reproductive health status.
 

You should also be aware of the caveat that only legally married couples can use their frozen eggs for procreation in Singapore.

At what age should you do elective egg freezing?

If you are feeling the pressure of your biological clock ticking away, you are not alone. Thanks to advancements in science, women in their 30s can hold on to the hope of becoming pregnant later in life. But you might be wondering, what is the ideal age for an EEF?

According to research, the success of EEF decreases as the age of the woman increases. Therefore, it is recommended to consider EEF at an earlier age for the highest chance of success. The study suggests that the ideal age for egg freezing may be before 34, with the highest success rates observed at younger ages.

The clock is generally more forgiving than you think, as the same study found that at age 37, the probability of having a baby with EEF was 51.6%, compared to 21.9% with no action. This shows that there are still benefits of freezing your eggs by age 37.

It is well known that age is a major determining factor in fertility. But a lot more problems can arise from factors other than age and some problems that manifest in your 30s or 40s could have been there even in your 20s.

Preparing yourself mentally for Elective Egg Freezing

Regardless of your reason for egg freezing, the hormonal shots can cause emotional ups and downs. But there is also the added uncertainty of the number of eggs that may get retrieved per cycle as well as the probability of the procedure failing.

It is totally normal to feel a rollercoaster of emotions on this journey. Finding and fully leaning into your support system can make the entire process less overwhelming.

You can also tend to your emotions by practising a bit of self-care, addressing any sources of anxiety, and finding ways to cope with them.

Elective egg freezing takes effort with many medical appointments, hormonal changes, and more. While certain aspects of fertility are outside of your control, being proactive by educating yourself about EEF and caring for yourself can help you feel empowered throughout the process.

It also helps to have a positive mindset shift by:

• Taking things one day at a time
• Spending time doing hobbies
• Journaling
• Talking to friends
• Doing stress-relieving exercises

What happens before egg freezing?

Most women who underwent elective egg freezing considered the process for at least a year before actually undergoing a cycle. This suggests they likely invested significant time in understanding the procedure, assessing their options, and preparing themselves emotionally and physically for the journey ahead.

If you are considering EEF, you can prepare yourself by:

• Doing moderate exercises daily
• Adequate hydration of at least 2L per day
• Eating a diet rich in fruits, veggies, and protein
• Avoiding alcohol, smoking and other recreational substances
• Getting at least 8 hours of sleep daily
• Taking micronutrient supplements as prescribed by your fertility doctor
  

What is the egg freezing process?

The egg-freezing process typically begins with a consultation with a fertility specialist. Once you have decided to move forward, then several steps follow:

1. Ovarian reserve testing: They are tests done to assess the quantity and quality of a woman's eggs in her ovaries.This includes ultrasound and blood work and helps estimate how many eggs can be retrieved. It also helps counsel patients at risk of getting very few eggs. 
   For patients 35 and under, the number of eggs needed for the best chance of having a baby depends on maternal age and whether genetic testing was done. Sometimes, multiple egg-freezing cycles are recommended to get the desired number of eggs. The process typically takes between 10-14 days.
2. Ovarian stimulation: This step involves a series of injections with hormones to make your ovaries produce more eggs (stimulate your ovaries). This may last about 8-12 days. Ultrasound monitoring is also performed to monitor the development of your eggs. Two days after, you will have a quick procedure where a needle is guided by ultrasound (ultrasound-guided needle aspiration) through the vagina to collect the eggs. Keep in mind that you will need to rest for 1-2 days after this procedure, so it helps to take some time off work during this period.
3. Egg freezing: The retrieved eggs are frozen through vitrification (a process that allows rapid cooling of eggs and leads to a glass-like solidification). This prevents damage to the eggs.
4. Storage: The frozen eggs can be stored at the fertility clinic until you are ready to use them and can be moved to another location if necessary.

Egg Freezing Hormone Side Effects

The hormone crash blues are very much real after the egg freezing process, although not everyone will experience them.

Following egg retrieval, there is a sudden drop in hormone levels which can lead to mood swings, emotional sensitivity, and feelings of sadness or anxiety.
If you find yourself struggling with these symptoms, know that you are not alone.

Seeking support and information on managing the hormonal side effects of egg freezing is important.

Additionally, other common side effects after egg retrieval may include bloating, cramping, fatigue, and pain at the injection site. These side effects are normal and will gradually subside in about 2 weeks.

Ovarian hyperstimulation syndrome (OHSS) occurs when the ovaries become swollen and painful due to overstimulation by fertility medications, resulting in the production of too many follicles. It is a common complication for women undergoing egg freezing. It can manifest with symptoms such as abdominal pain, bloating, nausea, vomiting, and weight gain. You should see your doctor immediately if you are experiencing any of these symptoms.

Conclusion

Elective egg freezing, or oocyte cryopreservation, offers women the opportunity to preserve their fertility for future use. Arming yourself with all the information on egg freezing, preparing yourself emotionally and physically, and seeking support are crucial steps on this journey.

By: Halimat Issa

FAQs: Elective Egg Freezing in Singapore

How much does it cost to freeze an egg in Singapore?

The cost of one cycle of egg freezing in Singapore is between S$10,000 and S$12,000. This estimate is inclusive of GST and three years of storage, according to the National University Hospital.

Is egg freezing illegal in Singapore?

Elective egg freezing became legal in Singapore in July 2023, following the implementation of regulations for Assisted Reproduction (AR) under the Healthcare Services Act. However, since elective egg freezing is not considered a medically indicated procedure, subsidies, co-funding, or the use of MediSave for egg retrieval and/or storage for this purpose are not available.

Is 38 too late to freeze your eggs?

Singapore recently raised the age limit for women who want to undergo elective egg freezing(EEF) from 35 years to 37 years. However, there are plans in place to keep monitoring local and international evidence to assess the age limits for egg freezing.

Is 7 eggs good for egg retrieval?

Following egg retrieval, a higher live birth rate was observed when 15 or more eggs were frozen per patient. The study reported a 48% pregnancy rate per embryo transfer and a 35% live birth rate per embryo transfer.

Can you get pregnant after elective egg freezing?

Yes you can. Every month, during ovulation, each egg competes to get fertilised. So, the procedure will not affect your fertility down the road. But you should know that the amount of your ovarian reserve can affect your chances of conceiving.

What are the signs of poor egg quality?

Poor egg quality can not be measured using conventional methods. But signs like unexplained infertility, advanced maternal age over 37, and recurrent miscarriages can be indicators of poor egg quality.

How many eggs do I have?

In women, it is estimated that an ovary contains around 300,000 eggs (oocytes) at birth. Since most people have two ovaries, this means about 600,000 eggs per person. The number of eggs in a person’s ovaries decreases as they get older. It reduces by half when they reach puberty and decreases to one-third by the age of 20.

Is embryo freezing better than egg freezing?

When comparing embryo freezing (where fertilised eggs are frozen) to egg freezing, it’s important to consider that not all frozen eggs survive the thawing process. Additionally, since eggs are frozen without being fertilised, it’s challenging to know if they’re healthy even before the freezing process. Frozen embryos may offer a higher chance of transferring healthy, fertilised eggs, which improves the likelihood of getting pregnant.

What is ovarian reserve testing?

They are tests done to predict a woman’s fertility, response, and outcome prior to fertility treatments. The most widely used tests are basal follicle-stimulating hormone, anti-Müllerian hormone, and antral follicle count.

What does a low AMH mean?

Anti-Müllerian hormone (AMH) is a biomarker that is used to assess ovarian reserve and predict fertility outcomes. Low AMH levels indicate a reduced number of ovarian follicles and can be associated with decreased fertility and poor response to fertility treatments.

When I am ready to use my eggs, will I have to undergo IVF?

No, you have undergone a significant part of the IVF process by freezing your eggs. When you are ready, the next step would be thawing and fertilising the eggs through a process called intracytoplasmic sperm injection (ICSI). This involves injecting a single sperm directly into each egg to facilitate fertilisation. The fertilised eggs, now embryos, are then monitored for development in the laboratory for a few days before being transferred to the uterus in an attempt to achieve pregnancy.

Do I have to stop birth control before EEF?

Yes, it is important to stop birth control pills or hormonal patches as these methods are designed to prevent ovulation and are rather the opposite of what you are trying to achieve during egg freezing. Your healthcare provider will provide specific instructions on when to stop birth control based on your situation and treatment plan.

Is the procedure painful?

Because EEF involves a series of hormone injections to stimulate your ovaries to produce multiple eggs, you may feel some discomfort or mild pain during this phase. If you are afraid of needles, you may want to find someone to help you with the injections. Some women may experience bloating and discomfort similar to premenstrual syndrome (PMS) symptoms during ovarian stimulation. The egg retrieval procedure is performed under mild sedation and is typically not painful. After the retrieval, you may experience mild discomfort, which can be managed with over-the-counter pain relievers.

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