'Freezing my eggs was the best decision I've made'

'Freezing my eggs was the best decision I've made'
PHOTO: Melissa Yambao

Women in Singapore will soon be allowed to freeze their eggs for non-medical reasons to preserve their fertility. Women aged between 21 and 35 can undergo elective or social egg freezing, which is done for non-medical reasons, with the introduction of the Assisted Reproduction Services Regulations under the Healthcare Services Act early next year (2023).

Melissa Yambao, now aged 38, is delighted with the news. Back in 2015, she froze her eggs when she was diagnosed with Stage 1A breast cancer. At the time, childbirth hadn't even crossed her mind. She was aged 31, and living life in the fast lane, enjoying her soaring career in banking.

Back in 2015 medical reasons were the only way you could freeze your eggs in Singapore. Says Melissa, "Cancer treatments can affect fertility. When my oncologist, Dr Steven Tucker, raised the issue of fertility preservation whilst discussing my cancer treatment options, I shuddered at the thought of not having my own children." She immediately began investigating how to freeze her eggs, working with a leading local gynaecologist and obstetrician (who has since retired).

Several months of ultrasound scans and blood tests followed, to determine where Melissa was in her monthly cycle. She also had to undergo daily hormone injections for ovary stimulation and take oral pills for hormone management as she was a cancer patient. Though the initial steps seemed daunting, Melissa says she found the actual egg harvesting procedure quite easy.

"The whole process took about half an hour after which I was able to go home. I felt tender after the procedure and this was understandable. My doctor explained that our ovaries are usually the size of a nut, but mine blew up to the size of an orange, due to the number of eggs. The doctors were able to harvest and freeze around 10 eggs," says Melissa.

Melissa went through two rounds of egg harvesting and freezing before undergoing chemotherapy, so she has 20 eggs frozen. She hopes this will increase her chances of having at least two babies if she is unable to bear children naturally.

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Currently cancer-free, and still enjoying her career in banking, Melissa feels that she has bounced back from cancer stronger than ever. She makes time for regular health checkups and has taken up yoga, breathwork, meditation, ice baths, and pole dancing to keep her body healthy.

She hasn't used her frozen eggs yet but says, "Knowing I have that option in the future has made going through the process worth it. For me, it was one of the best things I have done for myself. I want an option to have my own family in the future, and having frozen eggs gives me a chance to have my own biological children. Will that really happen for me? Only time will tell."

She admits that she's heard comments from people that science shouldn't interfere with the miraculous process of producing life, but she counters, "Medical procedures like egg freezing and IVF (in-vitro fertilisation) do not make the process of birth any less miraculous. What these procedures aim to do is to give women the chance of experiencing motherhood."

To other women contemplating egg freezing, Melissa has this advice, "Make sure you understand why you want to do it. I was clear on why - I wanted to have more chances in my future to bear my own biological children."

But she admits the process can be emotionally difficult. "It helps to have support. I remember anticipating how many eggs would mature every cycle, and hoping we could harvest a lot of good ones. I can see how this can be a source of anxiety. "

She also suggests researching the procedure to understand what it entails, "The process can take weeks and it can include daily medication and injections, frequent blood tests, clinic visits and ultrasound scans. Then there's the procedure to harvest the eggs. I think it's important to understand it all, so you can be prepared mentally to go through the whole process."

Melissa says frankly, " I know having frozen eggs does not guarantee I get to bear children in the future — but nothing in life is certain. Freezing my eggs gives me a better chance to be a mother. For me, this was a good enough reason for me to through it."

Here's what you need to know now about egg freezing in Singapore:

1. What is egg freezing?

A woman is born with a finite number of eggs. The number and quality of eggs decline as she ages. This means her chances of getting pregnant naturally decreases as she age. But egg freezing preserves fertility, to an extent, because the egg's age remains unchanged from the moment it is frozen

Freezing a woman's eggs, scientifically known as oocyte cryopreservation, is a process that involves stimulating the ovaries with injections of hormonal drugs, so the ovaries produce multiple eggs. "After about 10 days of injections, most women are ready for egg collection. This is usually done under general anaesthesia and takes about 20 minutes. Patients can go home shortly after that," explains Dr Andrew Kan, Fertility Specialist at Virtus Fertility Centre.

After the eggs have been extracted, they are examined in a lab and mature eggs are frozen. Most clinics use a flash-freezing method called vitrification that freezes eggs at 1190 Celcius in under one minute. Vitrifaction is preferred nowadays because it has a much higher survival rate for eggs after they are thawed.

In Singapore, only legally married couples will be able to use their frozen eggs to try for a baby through IVF

2. Is egg freezing safe?

While the egg removal procedure itself is considered safe, the intensive hormone shots can raise a woman's risk of ovarian hyperstimulation syndrome, or OHSS. This happens when a woman's body reacts too strongly to the hormone shots. Her ovaries become swollen and painful and she will experience a tender stomach, nausea and vomiting. In severe cases, OHSS increases the risk of kidney failure and blood clots and can even be fatal.

OHSS tends to happen in younger women in their 20s and 30s, and experts say it occurs in less than five per cent of patients.

3. How successful is egg freezing, when it comes to having a baby?

Egg Freezing is not a fertility guarantee. The chance of a frozen egg leading to a baby being born is about 2 per cent to 12 per cent, according to the American Society for Reproductive Medicine. Other studies put the figure at about 10 per cent to 50 per cent, at best.

The reality is that the success of IVF is based on a number of factors, including a woman's age, the age and quality of her eggs, and the quality of her partner's sperm. Says Dr Kan, "The most important thing is the age of the woman when the eggs were frozen - she's ideally less than 35 years old. And the actual number of eggs frozen - ideally 20 or more. There are also other considerations that affect the success rate, including her partner's factors and her uterine factors."

There are also no large studies on how long you can freeze eggs. Current studies into frozen eggs used for IVF treatment focus on eggs that have been frozen for a few weeks or months, not years. However, experts point out that technology is always advancing. "Vitrification of eggs is one of the biggest advancements in egg freezing. Before this we had a slow freezing technique, which did not yield a good survival rate for the eggs, " says Dr Kan.

4. Why would a woman want to freeze her eggs?

Some women choose to freeze their eggs for medical reasons. For example, ovarian cysts or endometriosis can affect how well the ovaries work. And cancer treatment can be toxic to the ovaries and cause premature menopause.

Other women just haven't found Mr Right yet. Dr Kan says some of his clients, "Are concerned about their future fertility and their current relationship or work commitment not enabling them to have a baby right away."

Less than 10 per cent of women actually go on to use their frozen eggs to try for a baby, according to some overseas studies. It could be that some women get pregnant naturally, or they adopt? Or maybe they decide life circumstances make it impossible for them to have a baby? No one knows the exact reasons why.

5. How much does it cost to freeze your eggs in Singapore?

As far back as 2012, the Ministry of Health said it was reviewing the medical, scientific, and ethical implications of social egg freezing. In 2019, the Ministry of Social and Family Development said it was "carefully reviewing" social egg freezing. And in July 2021. the PAP Women's Wing and Young PAP asked the Government to allow elective egg freezing.

But such careful thought is necessary. Egg freezing needs a healthy bank balance and a healthy body. The estimated cost of one cycle of egg freezing is S$10,000. Plus you need to pay monthly storage fees, which can be up to $1000 a month. And then there is the cost of the eventual IVF treatment. The costs of IVF treatment are typically between $10,000 and $15,000 per cycle at the three public hospitals in Singapore that currently offer IVF treatments.

Your body's own health is important. "A woman should be as healthy as possible during the egg freezing. It is best not to be smoking, drinking too much alcohol, or taking an exogenous medicine, " says Dr Kan. He adds, "Women need to know all the pros and cons of egg freezing, and whether it is right for them. It is not a panacea for all reproductive problems, and in certain cases, we would advise against it."

This article was first published in The Singapore Women's Weekly.

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