What you need to know:
- Although birth control allows a woman to decide when they get pregnant, fertility treatments can help them conceive when they are ready.
- If you want to delay having children or protect your dreams of having a family, freezing your eggs may keep that possibility open for your future.
When Phiona N Ngoga, the director of Rape Hurts Foundation miscarried a second time, she decided to see a fertility specialist, especially since she knew she had Polycystic ovary syndrome (PCOS).
After the second miscarriage as a result of a blighted ovum (when a fertilised egg implants in the uterus but does not grow into an embryo), she needed a medical cleaning of the uterus, which scarred her fallopian tubes, decreasing her chances of getting pregnant.
PCOS had also affected her egg quality and performance, which was one of the reasons she was miscarrying.
To increase her chances of having a baby, she resorted to IVF.
“The injection, taken every day on the stomach would bloat me to the extent of appearing pregnant. One day, someone congratulated me for being pregnant and this was painful, especially with what I was going through,” she says.
Because she had PCOS, Ngoga also had many, but small follicles. The treatment process, therefore, caused Ovarian Hyperstimulation Syndrome (OHSS).
“It was so painful. My embryo transfer could not be done until a month later, when I had healed from it. The embryos in the meantime were frozen until I was ready for implantation,” she says.
Now, a mother of twins, Ngoga looks back at her journey wishing people would show empathy towards others, especially when they do not know their story. She is one of the many women who have been able to give birth after, embracing one of the many options of fertility such as cryopreservation (a process that preserves organelles, cells, tissues, or any other biological constructs by cooling the samples to very low temperatures).
Freezing one’s eggs is one way of having children in future. During the process, a fertility specialist collects a woman’s eggs, freezes them and these eggs are thawed when it is time for implantation.
Dr Hilary Aheisibwe, an embryologist and fertility specialist at Neocare Clinic and Fertility Centre in Mbarara, western Uganda, says after carrying out all the necessary tests, a woman goes through ovulation induction, where she is given medicine to aid rapid growth of her eggs and achieve the number and size suitable for implantation.
The process takes between three weeks to about 45 days. A woman is given medicine (including folic acid) to induce periods. When periods begin, she is given hormonal injections as eggs mature. After 45 days, the eggs are mature for harvesting.
“We pick the eggs from the ovary using a needle as guided by an ultrasound. The eggs are located in follicles in the ovary. After removing the eggs, we can do two things; directly freeze the eggs or fertilise them with sperm to get embryos, which we then freeze,” Dr Aheisibwe says, adding that the eggs are stored in Nitrogen and the freezing process takes less than an hour.
They also have to be labelled properly with markers that cannot be erased. An inventory is kept, making the eggs easy to identify even after 30 years.
After the two to three weeks IVF process, when the eggs are mature, they will be collected while one is under general anaesthetic or sedation.
At this point, according to the Human Fertilisation and Embryology Authority, instead of fertilising the eggs with sperm, a freezing solution is added to protect them. They are then frozen and stored in tanks of liquid nitrogen.
The eggs are thawed and those that have survived intact are implanted, after being fertilised with a partner’s or donor sperm. About seven to 14 eggs are collected from most patients under 38 years of age.
Freezing the embryo
For a woman who already has a partner but is not ready to start a family, after harvesting the eggs from the ovary, they are fertilised with the partner’s sperm to get embryos. The embryos are frozen until the couple is ready to have a child.
“We normally fertilise more than one egg so that incase the woman wants to have more children, they do not go through the same process of treatment and harvesting eggs,” Aheisibwe says.
Freezing ovarian tissue
This is for girls who have not started ovulating and, therefore, are too young to take the drugs required to mature the eggs. Using laparoscopy, the surgeon cuts a small tissue of their ovary and freezes it.
“When ready and mature to have a child, we take the ovarian tissue to the laboratory, thaw it and subject it to media that causes growth of eggs in real life. Through this, we can produce as many eggs as possible,” Aheisibwe says.
Ovarian tissue, he adds, has capacity to go through regeneration, just like bone marrow. The eggs can be grown using the ovarian tissue, fertilised and embryos transferred to the womb. This service, however, is not yet popular in Uganda.
OHSS, according to Mayo Clinic, is an exaggerated response to excess hormones. It usually occurs in women taking injectable hormone medications to stimulate the development of eggs in the ovaries. OHSS causes the ovaries to swell and become painful.
This, Aheisibwe says, happens in rare cases. During the induction treatment in normal doses, hormones consume the medicine differently. The ovules might grow faster or someone has many eggs than the ovary can hold, causing abdominal pain that will not go away.
Under the care of fertility specialists, it can be discovered early enough, and one is subjected to standard treatment for three to five days. Other side effects can include nausea, vomiting, malaria, endometriosis among others, which are mostly mild cases.
Why these fertility options
Systemic lupus erythematosus (SLE), the most common type of lupus, is an autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage in the affected organs. It can affect the joints, skin, brain, lungs, kidneys and blood vessels and is also damages a woman’s eggs because of the strong immunosuppressive medications that may be used during treatment.
According to Centres for Disease Control and Prevention, women of childbearing age (15 to 44) are at greatest risk of developing the disease.
According to Dr Aheisibwe, most people who go for cryopreservation are cancer patients, about to start chemotherapy. The doctor says it is a patient’s right to know about these fertility options since chemotherapy may destroy a woman’s eggs alongside cancer cells.
Taking long to find a partner
When Priyanka Chopra, an Indian actress was freshly single in her early 30’s, she decided to freeze her eggs as she waited for her dream man.
“It is expensive, so one has to save up for it, just like one saves money to buy a car or house. It takes a month of your time but you have genetic security for a lifetime,” the Citadel actress revealed in her interview with TheWrap.
According to Dr Joseph Nsenga, a gynaecologist and medical director at Bethany Women's and Family Hospital in Kampala, the best time to go ahead with cryopreservation is between 25 and 35 years of age. The ovarian reserve, he says, is at its peak around this time.
If for some reason there is a fire, these eggs can be damaged. However, laboratories have looked at all these shortcomings and the chances of this happening are minimal. Also, as part of the consenting process, the person bears responsibility.
There are costs associated with every step, including initial tests, injections and medication for stimulation, physician visits, egg harvesting, annual storage fees and implantation. Depending on the facility, the rates may range between Shs5m and Shs20m.
Many requirements are factored in, such as the media for freezing, medicines and the length of storage, among other things.
For sperm freezing, the rates range between Shs3m and Shs5m since the procedure is not as complicated.