Despite prior controversies among supporters and opponents of the practice, egg-freezing has been growing in popularity among Egyptian women, with various explanations being offered.

The country’s marriage rate is declining, falling from 10.1 per cent in 2016 to 8.7 per cent in 2020. Furthermore, according to data published in 2017 by the Central Agency for Public Mobilisation and Statistics (CAPMAS), the proportion of unmarried individuals aged 35 and older has risen to 39.1 per cent for males and 31.5 per cent for females.

“There has been a recent surge in interest in the procedure of egg-freezing at medical clinics,” said Kamel Salem, a specialist in obstetrics, gynaecology, and IVF in Cairo.

“Approximately 15 per cent of patients who undergo ovarian stimulation and egg-harvesting at my clinic choose to freeze their eggs for future use, such as delaying childbearing for personal or professional reasons, preserving fertility before undergoing cancer treatment, or recovering from an illness that requires a long time for treatment,” he said.

Magued Adel Mikhail, a consultant in assisted reproduction and IVF, said that “during my time in England I froze eggs for women working for various international companies, including Apple and Facebook.

“These companies offer health insurance to their employees to freeze eggs as compensation for working long hours, which may prevent them from starting a family until later in life. Freezing eggs helps to maintain their quality, as a woman’s stock of eggs diminishes and their quality deteriorates after the age of 35. This means that a 45-year-old woman can use her frozen eggs that were preserved when she was 10 years younger, providing her with a better chance of having a healthy pregnancy.”

According to one Cairo investment consultant who asked to remain anonymous, “I decided to freeze my eggs twice; the first time when I was 37 and the second time when I was 39. I was determined to choose the right father and form a successful family that valued societal responsibility.

“I did not want to have to rush into marriage because I wanted to have children. Motives like that could destroy our society and the lives of future generations. A huge number of family court cases can be attributed to people rushing into marriage to have children without choosing the right partner.”

According to Mikhail, “freezing their eggs can also be a necessary option for women with certain health conditions that require ovarian surgery or for patients who have an ovary that forms cysts. Some women also suffer from immune diseases that can cause menstrual irregularities, common among women in Upper Egypt and probably due to neglecting proper healthcare until their menstrual cycle completely stops.

“Other women may experience a weak stock of eggs at an early age, some as early as their 20s. I advise such women to undergo an egg-stock examination to determine their quantity. If the ratio is between 1.5 and two, they can wait for a while before considering freezing their eggs. However, if the ratio is less than one, it is recommended that the woman takes immediate action by freezing her eggs or pursuing other fertility options that may be more convenient for her if she wants to increase her chances of pregnancy.”

Madline Kelada, an assistant at a women’s fertility clinic in Cairo, spoke of how egg-freezing has become more popular over the last couple of years. 

“I encounter women daily who undergo IVF at the ages of 38 and 42 and express regret for not freezing their eggs at a younger age. This is because they may only get one or two eggs suitable for fertilisation, which can reduce the success rates of IVF,” she said.

 “During my five years at the clinic, the last two have seen an increase in women between the ages of 25 and 30 coming in to freeze their eggs. Many are concerned about late marriages. There are instances as well of married women whose spouses spend long periods abroad. They freeze their eggs to preserve their quality until their return.”

SOURCE OF HOPE

“Egg-freezing is a source of hope for many patients, particularly cancer patients, as one session of radiation therapy on the pelvic region during cancer treatment is enough to halt the activity of the ovaries,” said Amr Heweti, an oncology consultant in Cairo.

“Radiation therapy to the pelvic area, certain chemotherapy drugs that have a direct effect on the ovaries, and the treatment of some cancerous tumours such as lymphoma and sarcoma can all negatively impact a woman’s overall ability to conceive. We counsel any patient who comes to us with a tumour and whose treatment plan threatens her fertility to consider egg-freezing if she wants to preserve her chances of having children after treatment.”

An accountant who uses the initials E L recalls that “I first learned about egg-freezing when I was at the oncology centre. Before starting my cancer treatment, I went to a fertility centre and froze my eggs. I was able to harvest 15 eggs, and nine of them were suitable for fertilisation,” she said.

“The development of the egg-freezing method in Egypt and around the world has contributed significantly to its widespread use,” said Mohamed Bahaa, an assistant professor of obstetrics, gynaecology, and IVF at the Al-Qasr Al-Aini Hospital in Cairo.

“In the past, we used to experience a damage rate of up to 50 per cent of frozen eggs when attempting to thaw them, but with advances in freezing technology, this percentage has decreased to 15 to 20 per cent.

“There has been significant technological progress in egg-freezing techniques over the past seven years, both globally and in Egypt. We used to freeze eggs slowly, starting at room temperature and gradually lowering it to -196 degrees Celsius, said Aly Hossam Mowafy, director of the Microscopic Injection Laboratory at the Al-Qasr Al-Aini Hospital.

“This process required about four and a half hours, making it vulnerable to damage in case of equipment failure during that relatively long period. But with the advent of super-cooling technology, we can now freeze eggs at the required temperature in a matter of minutes. Technological advances have also enabled us to treat and strengthen immature eggs harvested from the mother, making them more resilient to fertilisation and reducing the loss rates of retrieved eggs.”

“The Al-Kasr Al-Aini Hospital’s Preserving Fertility Unit offers egg-freezing technology as part of a group of clinics dedicated to women’s health in line with the Egyptian leadership’s commitment to women’s well-being. The unit’s main objective is to provide cancer patients with egg-freezing technology and to preserve ovarian tissue before starting chemotherapy and radiotherapy. To date, we have successfully frozen a portion or the entire ovary for 18 patients with cancerous tumours,” he said.

“Egg-freezing can help maintain a woman’s fertility and enhance her chances of conceiving over time, but it is not a fool-proof solution. The procedure involves multiple stages, including freezing the eggs, then retrieving, fertilising, and implanting them into the mother’s uterus via microinjection. Success in these stages is influenced by several factors, such as the success rate of the microinjections, which can be as high as 65 per cent in the best-case scenario. Additionally, there are other variables, such as the quality of the sperm from the father.

“There is also a risk of complications during and after the egg-harvesting procedure. The process starts with injections to stimulate the ovaries to produce more than one egg per cycle, and the eggs are then harvested through one of three routes: the vagina, the anus, or the abdomen.

“Usually, the first technique is avoided in order to maintain virginity before marriage, but eggs withdrawn through the anus risk contamination, leading to infection. When eggs are extracted through the abdomen, patients are exposed to the usual risks of a laparoscopic procedure. However, an experienced doctor can help patients to avoid complications during the harvesting procedure. Additionally, the procedure is simple and usually takes about 15 minutes, and complications are rare.

“After the egg-harvesting procedure, it is possible for the patient to experience a condition known as ovarian hyperstimulation syndrome (OHSS). This occurs when the ovaries secrete too many eggs after stimulation during the procedure, and it can lead to complications. Since the ovaries are larger than usual after the egg-withdrawal procedure, we advise the patient to rest completely to prevent complications such as a condition known as ovarian torsion that can reduce the blood supply to the ovary and potentially result in gangrene — a life-threatening complication,” Bahaa explained.

“In cases of severe pain on either the right or left side of the abdomen, vaginal bleeding, breathing difficulties or vomiting, the patient is advised to seek immediate medical help, to minimise the risk of complications. It is also important to follow up with a clinical examination and constant care for three days following the egg-retrieval procedure.”

CONTROVERSIES

One patient, Sama Salam, a Cairo science teacher who chose to use a pseudonym, said that “I suffered from hyperstimulation after the egg-retrieval. I had to stay at home for about 10 days following the procedure. My blood pressure was low, and I had to follow up with my doctor to receive an IV and antibiotics to prevent complications.”

Besides the medical considerations weighing on embracing egg-freezing option more broadly, there is also some controversy over it in Egypt. Hisham Al-Wakil, professor of oncology at the Faculty of Medicine at Ain Shams University in Cairo, said that “many oncology patients who are advised to freeze their eggs before starting treatment refuse to undergo the procedure. Some prefer to take the risk and hope to conceive naturally after the treatment, which has a success rate of 50 per cent. Others decline egg-freezing due to the additional costs involved.

“Another obstacle to the demand for egg-freezing could be the recent jump in the dollar exchange rate. Depending on the response in each case, a patient may require between LE6,000 and LE10,000 for the activation injection. This is in addition to the LE10,000 to LE12,000 for the egg-retrieval, followed by the annual cost of freezing the eggs, which comes to LE1,000 per year. Moreover, a patient may need to repeat the procedure more than once to collect an acceptable number of fertilisable eggs,” Mikhail said.

There can also be a fear of eggs mixing. Salam’s family expressed concerns about the possibility of eggs mixing after she underwent an egg-harvesting procedure, blaming her for this potential risk. However, modern fertility clinics have advanced systems to prevent such mix-ups from occurring.

According to Mowafy, doctors are used to being responsible for handling and storing samples. Even though each preservation tank contains up to 950 specimens, they can locate each in under 30 seconds, he said. Each egg and embryo sample is labelled with the name of the woman (in the case of an egg) or the wife and the husband (if it is an embryo), along with a specific colour and number, ruling out the danger of any mix-ups.

---

* A version of this article appears in print in the 9 March, 2023 edition of Al-Ahram Weekly