15th May 2013 | by Dr. William Buckett
What are the costs of social egg and sperm freezing in Canada and are any of these costs covered by provincial health plans? Are there any risks involved with these methods of fertility preservation and how long can eggs and sperm be safely stored?
Written by our medical expert, Dr. William Buckett.
Social egg freezing is when a woman chooses to have some of her eggs frozen, usually before the age of 35, for the purpose of avoiding the decline in fertility that is associated with aging. This is called social egg freezing because the process is being undertaken for personal rather than medical reasons (such as cancer treatment). Similarly, social sperm freezing is when sperm is frozen for later use.
Sperm Freezing
Sperm freezing involves the cryopreservation (freezing) of a semen sample, usually produced by masturbation. Sperm cryopreservation has been used for over 50 years. Although frozen sperm are less sensitive to cryopreservation damage than many other cell types, the process does cause some reduction in sperm motility and fertilization capacity compared to fresh sperm (1). That said, there have probably been over 1 million babies born from frozen sperm with short- and long-term follow-up demonstrating no greater rates of abnormal development than with fresh sperm. This means social sperm freezing is a very viable form of fertility preservation. Twenty-one years is the longest length of time sperm has been successfully frozen and thawed and resulted in a healthy baby (2). There is legislation in some countries which limits the length of time sperm can be frozen for, although there is no legislation at present in Canada. Overall, producing sperm for freezing involves little risk to the man and although the fertility potential from frozen-thawed sperm is slightly less than fresh sperm, it is still a very effective way of preserving fertility in men. The costs of social sperm freezing are not currently covered by provincial health care plans in Canada, and range from $200-$500 to initially freeze a sample and then $200-$400 per year for storage.
Egg Freezing
Egg freezing is more complex. This process involves some small risks to the woman and requires more time, more treatment, and more medical monitoring than sperm freezing. It is also significantly more expense. To obtain eggs for cryopreservation (freezing) the woman has to go through ovarian stimulation (as if she were going through IVF). This involves a variety of different treatment regimens designed to stimulate the ovaries to produce multiple eggs. This stimulation carries a 1% risk of ovarian hyperstimulation syndrome – a serious complication that may necessitate hospital admission. In order to retrieve the eggs a needle is inserted into the ovaries through the vagina – this carries a small risk of pelvic infection (1/200-1/500 cases) or serious bleeding (1/5,000-1/10,000 cases) (3). Until fairly recently, egg freezing was not a viable way to preserve fertility. However, new methods of rapid egg freezing have led to the establishment of egg freezing as a more viable option for women who wish to preserve their fertility. Current cryopreservation techniques are very encouraging. However, the fertility potential from frozen-thawed eggs is still reduced compared to fresh eggs. And with under 5,000 babies born from frozen-thawed eggs, there isn’t enough long-term follow up to know if there are higher rates of congenital or developmental abnormalities with egg freezing versus spontaneously conceived pregnancies. Until there is more data, we still don’t know how effective social egg freezing is as a strategy for fertility preservation. With that in mind, it has been suggested that women should freeze their eggs before the age of 25 years (4) and certainly before the age of 35. The length of time eggs can be frozen is unknown – so far there have been no cases of pregnancy and delivery where the egg has been frozen over 10 years. Social egg freezing is not covered by provincial health plans. Costs across Canada are in the range of $6,000-$15,000 for the medical process and initial egg freezing. The costs of medication may be extra – typically in the range of $2,000-$5,000 depending on the woman’s age. Continued storage is in the range of $300-$700 per year.
References
1. Cross NL, Hanks SE. The effects of cryopreservation on human sperm acrosomes. Human Reproduction 1991; 6: 1279-1283
2. Horne G, Atkinson AD, Pease EH, Logue JP, Brison DR, Lieberman BA. Live birth with sperm cryopreserved for 21 years prior to cancer treatment: case report. Human Reproduction 2004; 19: 1448-1449.
3. Ludwig AK, Glawatz M, Griesinger G, Diedrich K, Ludwig M. Perioperative and post-operative complications of transvaginal ultrasound-guided oocyte retrieval: prospective study of >1000 oocyte retrievals. Human Reproduction 2006; 21: 3235-40.
4. Wunder D. Social freezing in Switzerland and worldwide – a blessing for women today? Swiss Medical Weekly. 2013; 143: w13746.
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