Oocyte freezing and bioethics law, where do we stand?

What is an oocyte?

The oocyte is the reproductive cell of women. Unlike men, whose spermatozoa are renewed every three months after puberty, women have a predefined ovarian reserve from birth, since it is built up in the mother's womb during pregnancy. The more time passes, the more this ovarian reserve diminishes. A woman over the age of 40 will certainly be less fertile than a woman of 25. The probability that a woman will become pregnant is therefore directly related to the quality and quantity of her ovarian reserve. It is considered that a woman has during her lifetime nearly 400 follicles or eggs that will lead to ovulation.

How do you know if you should freeze your eggs?

In general, very few women are concerned about their ovarian reserves. Until now, people who were prescribed egg freezing were suffering from chronic diseases such asendometriosis or cancer. The objective was to allow them to preserve their eggs of good quality and in sufficient quantity before undergoing surgery or chemotherapy. In today's society, women and couples are deciding to have children later than the generation of the 60s and 70s for many reasons. More and more couples are finding it difficult to conceive, with infertility at the time of conceiving a child. In recent years, some women have decided to resort to egg freezing in order to preserve their reproductive capacity over time and give them a better chance of conceiving when they decide to have a baby. It is possible to know the ovarian reserve by taking blood tests. An anti-müllerian hormone (AMH) test should be prescribed by a doctor. The AMH level must be in equilibrium according to your age. If the AMH is low, it may indicate ovarian failure. If the AMH is too high it could be a sign of polycystic ovary syndrome. An elevated follicle stimulating hormone (FSH) level can indicate ovarian aging. If inhibin B is low, you may have a follicular cohort, meaning that your follicles are maturing during the follicular phase. Finally, your estradiol level reflects the quality of your ovarian secretion.

When should I freeze my eggs?

Unless there is a clinically proven and urgent case, it is advisable to freeze your eggs as soon as possible in order to harvest good quality eggs in quantity. By law, women must be at least 45 years old to freeze their eggs. Furthermore, if you carry out examinations that show a low ovarian reserve, we recommend that you consult your gynecologist to discuss this.

What is egg freezing?

As mentioned above, oocyte freezing is a procedure that consists in preserving fertility of the woman using the method of vitrification of her oocytes or eggs. It is authorized in France under certain conditions according to the 2011 bioethics law. Freezing one's oocytes allows women to suspend their "biological clock".

How does egg freezing work?

• First, an appointment is made to learn about the condition of the patient (couple, single, diseases, ...). A series of examinations will be conducted: blood test, pelvic ultrasound to determine the chances of success of the ovarian puncture. The patient will be informed of the risks that may be involved in ovarian stimulation and egg collection.
• Ovarian stimulation will begin on the first day of menstruation and will last for 9 to 15 days. The objective of the stimulation is to increase the production and size of the oocytes in order to obtain about ten mature eggs at the time of ovulation. Where only one egg will be in a classic cycle. To ensure that the treatment is working properly, your gynecologist will have you undergo ultrasound and blood tests every two or three days.
• Ovarian stimulation involves the use of hormonal injections that must be given at set times every day of the treatment. It is important to follow your doctor's recommendations to the letter, as he or she will be able to give you the right hormones and the right dosage. It is also possible that your ovulation is controlled by an injection of Ovitrielle.
• Approximately 36 hours after ovulation is triggered, the follicles containing oocytes will be punctured in the operating room under ultrasound control. The follicles are then harvested through the patient's vagina. The ovarian puncture can be done under general or loco-regional anesthesia.

Who can have recourse to oocyte freezing in France?

The law regulates oocyte cryopreservation. More specifically, article L-2141-11 of the Health Code regulates this method. It states that "any person whose medical care is likely to alter fertility, or whose fertility is likely to be prematurely altered, may benefit from the collection and preservation of his or her gametes [...] with a view to the subsequent realization, for his or her benefit, of medically assisted procreation, or with a view to preserving and restoring his or her fertility."

Oocyte freezing is particularly aimed at women whose fertility is likely to deteriorate early (before the age of 40) as a result of various treatments, such as chemotherapy.

Oocyte freezing may also be used for donations. Women without children can then offer their oocytes for couples who cannot have children. This possibility was opened in 2016 and is extremely regulated by law.

Finally, it is possible to have recourse to oocyte freezing through in vitro fertilization. In vitro fertilization (IVF) is a laboratory assisted reproduction technique that consists of reproducing fertilization with the aim of forming an embryo. After follicular puncture, the sex cells of women and men are placed together in a culture medium at 37°C in a sterile dish. In the case of IVF by ICSI, a spermatozoon will be directly injected into the woman's follicle to create an embryo that will then be transferred.

What changes with the bioethics law

Since the bioethics law on medically assisted reproduction, published in the official journal on September 29, 2021, the periods are changing in France: all women aged between 29 and 37 can resort to oocyte freezing, without any particular medical reason.

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