VIDEO | Egg freezing, Daniela Galliano (Ivi Roma): “It doesn’t encourage late pregnancies”

Galliano: "Instead of blaming women, let's put them in a position to have children before the age of 30"

ROME – On average, a 30-year-old woman has a 69% chance of becoming pregnant. For every year of postponing motherhood, the chances of achieving pregnancy are reduced by approximately 5%.

And given the current pace of life, more and more women find themselves with a very low level of fertility when they decide to have children.

But today, thanks to the freezing of oocytes (or ‘egg freezing’), it is possible to preserve youthful fertility to increase the chances of having a child even at 40 or after an illness. In Italy, meanwhile, the number of girls and women who decide to resort to this technique is increasing.

But doesn’t this risk legitimizing late-life pregnancies, especially in a country like ours, which at a European level has more first pregnancies after the age of 40? Dire spoke about it with Dr. Daniela Galliano, director of the Pma Center (Medically Assisted Procreation) of IVI Rome.

– Doctor, meanwhile: what does this technique consist of?

‘It is a technique that consists in the vitrification of female gametes, therefore oocytes. Vitrification is a type of ultra-rapid freezing, thanks to which within a few minutes the cells go from room temperature (that of the laboratory) to -196° (which is the temperature of liquid nitrogen). In this very short period of time, ice crystals do not form in the frozen cells, which instead were created with the traditional technique of slow freezing, which took about two hours.

– What are the benefits of such rapid freezing?

‘It allows you to obtain excellent results and was a true revolution, because it changed reproductive medicine by offering women effective treatment strategies. When we go to thaw the oocytes today, as there are no longer any ice crystals inside them, we do not lose their quality, which remained ‘crystallized’ at the time of freezing. So those cells, those gametes, will have the same quality and therefore the same probability of pregnancy as when they were frozen.

– What are the ways to access egg freezing and what and how many steps are there?

‘In the meantime, we need to understand whether the woman is actually a candidate to carry out this treatment, whether she is in excellent health conditions and whether she has a good ovarian reserve to be able to freeze a sufficient number of eggs and obtain a good success rate in the future , when she is willing to have a pregnancy but has not achieved it spontaneously. The first step is therefore screening and a gynecological examination, after which the woman will be subjected to ovarian stimulation and will have to self-inject drugs for about ten days, with the aim of making the follicles contained in the ovaries grow. When the follicles have reached a good size, we will collect the eggs; in that case the woman will be slightly sedated and in a few minutes we will be able not only to collect the oocytes but also to vitrify them.

– What are the costs of cryopreservation?

‘The costs are around 3 thousand euros’.

– How long can oocytes be cryopreserved?

Do they have an ‘expiration’? And up to what age can embryos be implanted in women? ‘The oocytes do not have an expiry date, once they have been vitrified they can remain in liquid nitrogen for all the years necessary for the woman to be able to think about having a pregnancy. As for the age limit, reproductive medicine societies follow the maximum age limit of 50 years.

– Let’s talk about the chances of success of this technique: what do the scientific literature data say?

‘Scientific literature tells us that the probability of success depends on the age at which the oocytes were vitrified. As the IVI Group we have conducted a very important study, in which we can even see the number of oocytes thanks to which we are able to obtain a specific percentage of pregnancy and we have seen that in the group of women in which we vitrified oocytes under the age of 35 we managed to obtain extremely high success rates, around 90%; in the group of women who had vitrified over the age of 35, however, this success rate is extremely lower and reaches a maximum of 40%.

– Is there a message you would like to send to girls and women?

‘We must tell them that the vitrification of oocytes is an important tool for preserving one’s fertility, but it must be thought about before the age of 35; this is not because it is not possible to carry out the treatment afterwards but because everything must be done in order to offer the woman high success rates. It is important that women are informed about what science offers us today, especially in a society where the search for the first child is postponed compared to 30 or 40 years ago. And it is necessary to let women know that it is important to preserve fertility before the age of 35, because after that age fertility is halved, therefore not only does the probability of spontaneous pregnancy decrease but unfortunately the percentage of abortions due to embryonic chromosomal causes also increases. So it’s good to preserve the eggs, but you have to do it at the correct age.

– In this way, however, isn’t there a risk of increasingly legitimizing late-life pregnancies?

‘I disagree: when I recommend egg freezing I am not suggesting that women postpone motherhood. It is obvious that as a doctor I recommend women to get pregnant before the age of 35, not only because the probability of obtaining it is maximum at that time but also because in that age group the obstetric risks are lower.
Let’s ask ourselves, however, also how many women there are (few) in our society who can really afford, if desired, a pregnancy before the age of 30. This is a fact, so if I recommend egg-freezing I don’t do it because I want to replace welfare, on the contrary: I think that politics and medical prevention are two parallel paths but that they cannot be replaced in any way. I don’t think that egg-freezing is the solution to the birth rate in our country, even if Medically Assisted Procreation (PMA), from being a medical procedure to treat pathologies that hindered fertility, is increasingly becoming a resource for resolving the bad employment policies of our country’.

– The problem, in short, is upstream…

‘Exactly. Instead of blaming women, we should enable them to have children before the age of 30, offering them concrete solutions to job insecurity, the gender gap, the lack of services, just to name some of the problems that make it difficult to think about motherhood at a young age. age. Precisely for this reason, science tells us: ‘Look, if you cannot have a child before the age of 30 for reasons of job insecurity, because you are still studying or because you have not met a life partner with whom to form a family, know that science comes to your aid with this treatment’. This is very different from advising women to postpone motherhood and is certainly not what medicine is doing. Also because he would absolutely disagree with me.

– Are there any side effects related to the egg freezing procedure?

‘The side effects of ovarian stimulation today are practically non-existent. Many years ago it was possible to experience ovarian hyperstimulation which could cause side effects, in some cases even serious ones. But today, with stimulation protocols at low hormonal doses, this risk is eliminated. The only side effect that some patients may experience is some abdominal swelling at the end of the 10 days of stimulation. However, the symptom is absolutely reversible following the oocyte pick-up: after the appearance of the first menstrual cycle, everything goes back to how it was before.

– Cryopreservation and cancer patients: according to a study published last year in ‘JAMA Oncology’, undergoing fertility preservation procedures at the time of breast cancer diagnosis does not appear to be associated with any increased risk of recurrence or mortality specific to oncological disease. Is that so?

‘Absolutely yes: the data we have from the study cited but from the scientific literature in general reassure us: screening and follow up which have been carried out for more than 20 years in a very large group of women (over 20 thousand) who are followed over the years tell us that there is no increased risk of breast cancer in women undergoing ovarian stimulation compared to women of the general population who have never undergone PMA treatments.

– In Italy, meanwhile, there are still few girls who opt for egg freezing, yet we are the European country with the most first pregnancies after the age of 40. Why?

‘I think there is still a lot of misinformation, even though this technique is now widespread in many other countries, including the United States but also neighboring Spain. In Italy we are starting to talk about it especially now, so the requests from girls are actually increasing. Egg freezing is still not well understood and for this reason there is still a sort of fear and resistance; yet to make informed choices it is very important to inform yourself. Every day I see women who tell me: ‘If I had known this before, I would have opted for egg freezing.’ And this is a shame, we should be women who are informed about our health and prevention, especially in a country like ours where there is a large birth rate.