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Dr. Sunita R Tandulwadkar - OOCYTE CRYOPRESERVATION



Dr. Sunita R Tandulwadkar - OOCYTE CRYOPRESERVATION

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Ruby Hall Clinic is Pune’s first Nationally Accredited Hospital with 550-inpatient bed with staff strength of 150 consultants, 500 panel doctors and 1400 paramedical staff. The Ruby Hall IVF & Endoscopy has state-of-the-art technology and skilled specialists that strive to provide multiple services that are affordable & patient friendly.

Dr. Sunita R Tandulwadkar MD FICS FICOG is the Head, Department of Obstetrics and Gynecology and the Chief, IVF and Endoscopy Centre at Ruby Hall Clinic. She started the trend of laparoscopic hysterectomy and all advanced laparoscopic surgeries in Pune in 1995. She represents the Indian Association of Gynaecological Endoscopy (IAGE) as a Board Member, the Indian Society of Assisted Reproduction (ISAR). She was the Infertility Committee Chairperson (2011-2013) for the Federation of Obstetric and Gynaecological Societies of India (FOGSI). She has been bestowed with many awards, including the Sarvashree award, the PunyaShlok Ahilyabai Holkar award by the Ministry of Women and Child Development, Government of India, among many others.

OOCYTE CRYOPRESERVATION

As we all know, unlike men, a woman’s reproductive age is finite and depends on the number of eggs she is born with. Today technology has advanced to a stage where a woman has the option to actually stop her biological clock and concentrate on things as per her priority. Human oocyte cryopreservation (egg freezing) is a process in which a woman’s eggs (oocytes) are extracted, frozen and stored. Later, when she is ready to become pregnant, the eggs can be thawed, fertilized, and transferred to the uterus as embryos. This procedure is one of the advanced assisted reproduction technologies and is provided at India's few-advanced IVF centres.

Cryopreservation itself has always played a central role in assisted reproductive technology (ART). With the first cryopreservation of sperm in 1953 and of embryos thirty years later, these techniques have become routine. The reported world’s first pregnancy using previously frozen oocytes was in 1986. With advancement in technologies, women empowerment and equal rights to women, Indian women are tend to marry late and plan pregnancy almost in her late thirties. With increasing age, female egg quality deteriorates, which leads to inability to conceive or recurrent abortions. Egg freezing can also be beneficial for women who, for the purpose of education, career or other reasons, desire to postpone childbearing. Freezing eggs at an early age may ensure a good quality of (young) eggs and improve the chance for a future pregnancy.

What exactly is the procedure?

The egg freezing cycle involves taking daily hormone injections from second day of your period for around 10 days with ultrasound scans done to monitor the growth of follicles/eggs. Once the follicles have matured as determined by scan and blood oestrogen levels, the eggs are taken out under anaesthesia under sonographic guidance using a needle inserted through the vagina.

The egg is the largest cell in the human body and contains a high amount of water. When the egg is frozen, the ice crystals that form can destroy the integrity of the cell. To prevent this, the egg must be dehydrated prior to freezing. This is done using cryoprotectants, which replace most of the water within the cell and inhibit the formation of ice crystals.

Eggs (oocytes) are frozen using either a controlled-rate, slow-cooling method or a newer flash freezing much faster process known as vitrification. The result of vitrification is a solid glass-like cell, free of ice crystals. Vitrification is associated with higher survival rates and better development compared to slow cooling. During the freezing process, the zona pellucida, or shell of the egg can be modified preventing fertilization. Thus, currently, when eggs are thawed, a special fertilization procedure is performed by an embryologist whereby sperm is injected directly into the egg with a needle rather than allowing sperm to penetrate naturally by placing it around the egg in a dish. This injection technique is called ICSI (Intracytoplasmic Sperm Injection) and is also used in IVF.

Q. What are my chances of being pregnant following oocyte cryopreservation?

Success rate is measure by the number of pregnancies achieved after embryo transfer that were developed by using frozen-thaw egg and ICSI procedure. The percentage of transferred cycles is lower in frozen cycles compared with fresh cycles (approx. 30% and 50%). Such outcomes are considered comparable.

Q. Does freezing damages my eggs? Does it increase chances of birth defect in baby?

Yes, freezing thawing can produce stress into delicate cells like human the egg; we may loss some eggs while in process. But recent laboratory modifications in protocol regarding cryoprotectant composition, temperature and storage have resulted in improved oocyte survival, fertilization, and pregnancy rates from frozen-thawed oocytes in IVF. The recent studies showed that the rate of birth defects, chromosomal defects or developmental deficits when using cryopreserved oocytes is consistent with that of natural conception.

Q. Any side effects or complications of procedure I may have?

Stimulation of your ovary for multiple eggs production can lead to ovarian hyperstimulation syndrome (OHSS). Mild to moderate OHSS can be managed medically at home with rest and fluids; severe OHSS needs hospitalization and specific treatment. Repeating such a procedure can exhaust your ovary and can lead to early menopause. The procedure is technically simple and without any major complications. Very remotely it can cause internal bleeding or very rarely infection.

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