Discover everything you need to know about egg freezing in Czechia with Dr Tomáš Koukal, Fertility Specialist at @unicaclinic5906 Brno.
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#EggFreezing #SocialFreezing #FertilityPreservation #EggFreezingCzechia #FertilityAwareness #WomenHealth #IVFJourney #FertilityTreatment
Egg Freezing in Czechia: Options, Process, and Facts
Hello, good evening. Welcome back to my IVF offenses and the European fertiliz fertility society. We are back once again today and I’m really happy to have you all here with us and we are going to talk about social freezing in Czecha and we are connected with our special guest and expert today. You can see him right here. Dr. Thomas Kokal is with us. Hello Dr. Thomas. Lovely to have you. Hope you had a good evening, a good day so far and are ready to to discuss this topic with us today. Hello. Hi. Nice to meet you, Karolina. And uh hello everybody. Yeah, thank you so much. And uh of course we will start with the presentation on our topic but afterwards there will be time for your questions. So please remember to put your questions in the chat and Dr. Koko will definitely answer them for you right after the presentation. And I also would like to add that Dr. Kokal is the fertility specialist at Unika in Bruno. So we are um connecting today from the clinic. It’s quite late but I’m really happy that we are able to have you here and to discuss this as uh we know that this is a topic that uh definitely brings lots of questions. This is still, I would say, not a popular um treatment, but I’m really happy that we are able to to spread the word about it that something like that exists and uh people can find out a little bit more. So, um remember it’s all being recorded and it’s all anonymous. So, we are definitely happy to have any questions from you and we will be definitely um happy to answer them. So uh don’t hesitate and I think we can start with our presentation. Let me know if we can see it and we can start. Okay. So thank you again Karolina. Um thank you very much for this opportunity to be here with you and with the patients and good evening to everyone from Berno Czech Republic. It’s my pleasure to present to you more details about the egg freezing topic. So, uh let’s start. U what agenda will be discussed this evening and which topics will be covered. Um these four areas. Yeah. What is the egg freezing? Uh why do we freeze eggs? Who is recommended for this procedure? and uh how is this procedure done? Okay. So the first point to be discussed is the description of egg freezing or let’s say fertility preservation or social freezing. Uh it is fertility preservation process where a woman’s eggs are collected, frozen and stored for future use. And when the time feels right, the frozen eggs will be unfrozen and used to conceive via invitro fertilization. Why are we talking with your our patients about increasing? Because over time the quality and quantity of eggs declines and viaing we can solve this problem on the topic of uh of egg quantity. How can we detect it? Via antimmalaran hormone which is the best measure of ovarian reserve. Few facts about the AMH. This hormone is produced by granulosa cells in ovaries at many stages from primary to early antal stage of follicles. The concentration of AMH in blood is directly proportional to the number of antal follicles. AMH is a better indicator of ovarian reserve than FSH inhib or estradiol measured on day three of the cycle. and uh blood AMH levels do not change significantly either during the menstrual cycle or between subsequent cycles. And finally, from AMH levels, we can estimate how the ovaries will respond to IVF stimulation. who should be tested um via antimaran hormone. All women interested to know what their ovarian reserve is or have doubts about it. All women age over 30 years. All women uh with reduced antal follical count or predominance of ovarian stromal issue on ultrasound. All women after ovarian surgery, cytotoxic treatment like chemotherapy etc etc and all women with ovarian endometriosis. Here on the graph we can see the antimarin hormone levels declining over time as a woman ages. On the bottom we can see increasing age and on the left side we can see AMH levels. This graph is important because it shows clearly decreasing AMH levels as women get older. Now I would like to talk about the quality of X on this graph is relationship between the patient’s age and genetically normal embryos because only the genetically normal embryos can lead to the to the healthy pregnancy and to the healthy baby in your home. And we can see the accelerated decline after age 35. So it’s clear that the higher maternal age is associated with the lower embryo quality with the increased genetic abnormalities with a higher risk of miscarriages and uh reduced implantation success and steep decline in aloid embryos begins after age 35. This slide shows us a predictive model to estimate the number of mature oides needed to obtain at least one aoploid blastoyst for transfer in couples undergoing invitro fertilization. And there is clearly visible difference between younger woman as seen in top curved line compared to the bottom line which shows older woman. And by comparing these women we can conclude that 28 year old woman needs to collect circa three oides to have a 70% chance of obtaining at least one aoploid blastoist while on other side a 44 years old woman needs to collect expect approximately 34 oides to achieve the same 70% chance. So it it is the big difference. In this easy slide we can see the normal oides in green and abnormal in red. As it shows over time the quantity decreases and the number of normal oides decreases as well. Who is recommended for this procedure for for egg freezing? Uh historically it was on the first place the cancer patients. Yeah. woman women undergoing treatment like chemotherapy which are encouraged to consider egg freezing beforehand. The next could be recommended for carrier focused woman which are preserving options while building a professional life. Next for the awaiting woman awaiting the right partner or single woman not yet ready to build the family. There are some next there are some specific situations. If we have here the couple treated via IVF and there can be some problems on the on the male partner side like a health condition traffic jam and uh he is not able to be to be here on time. So and we have already collected eggs. So we have to we have to freeze the the uh his wife’s eggs and uh uh to save to save this collected eggs. Yeah. And um next could be recommended to do this procedure for patients with family history of early menopause to ensure that they have viable eggs for future use. What is initial analysis before this procedure? This is AMH blood test taken on any day of the menstrual cycle and vaginal ultrasound which can assess ovarian structural issues. How many eggs can be retrieved and uh antal follical count? How many eggs we want to achieve or what is our preservation goal for optimal future chances? This is between 15 and 20 mature eggs. However, this goal should be specified individually especially with the respect to age. Uh see see the previous previous slides. Yeah. What does the process look like? Yeah. In first first step is done the initial consultation and uh we are doing the evaluation and and planning all all steps uh from beginning of the menstrual cycle is hormone stimulation started. It means for 10 till 14 days using injections to prepare the ovaries for for growing follicles. Yeah. In this time on in this period is done mostly two times ultrasound scan to detect how many follicles there are in growing process. If there is the the if there are the sizes of follicles in optimal sizes. So uh we are you we have a plan for the egg retrieval. What is the 15 10 or 10 or 15 minutes procedure under general anesthesia? And after the collection of of these eggs, these eggs will be will be vitrificated um for for preservation and uh after few years or after many years uh will be the this eggs will be will be unfrozen and can be fertilized uh via sperms. terms and uh approximately 5 days after the this fertilization is done the embryo transfer or can be done the pre-implantation genetic testing of anoploides of embryos. With this procedure, we can detect which embryos are genetically normal and which embryos are genetically abnormal. And uh for the future will be will be again creep preserved the only genetically normal embryos which can only embryos can lead to the healthy healthy pregnancy. What does the stimulation process look like? Yeah, the first step is the stimulation is started from the second day of cycle. There is the self administered hormonal injections to stimulate the growing of follicles. Next uh during this 10 or 12 days period will be done the two one or two ultrasound controls during stimulation and uh in case will be there the optimal sizes of follicles will be will be done the the plan for the egg collection. Before this should be done the trigger shot injection which is used approximately 36 hours before the egg collection and uh after that the egg collection is done. What does the egg collection procedure look like? Uh it’s typically done on between days 11 till day 15. This procedure means that the woman will be at our clinic approximately two or 3 hours. This procedure is uh performed under general anesthesia. So is fully painless and uh the recovery time after this procedure is um is very quick and uh she can return to normal activities very quick. Now I will describe to you the case report. Yeah. Number one there was the 38 years old HR manager AMH has below one so bit lower than normal range. There was a pure follical count. There was a healthy BMA BMI range. Next condition there was the trombilia mutation of factor five leen and uh she was motivated for all sides freezing because she found the new boyfriend but not sure whether the to conceive with this partner yet there was done the first stimulation in November 23 we’ve been used the short antagonist protocol All with 300 units from day 2 till day 11. Due to the trombilia there was used an oxaparine injections. The it was the antagonist protocol. So we’ve been used gilex injections and the trigger uh injection was used via via tripelline and uh in this stimulating period there were two times where ultrasound for ecolometry is done and oite pickup uh was done on day 13 and the result was that there were 13 follicles in growing process 11 o sites uh were achieved and uh nine M2 sites was we creo preserved into three straws. After that three months later was done the stimulation number two in with same protocol 300 units of combinated gonadotropins and oxaparin was used again gan relics as well and the trigger shot via tripline and again there were two ultrasound 40 kometries on day seven and day 10. One one difference between uh the first and second stimulation cycle was that the egg collection the pickup of egg collection was done on day 14 and there were in the results nine follicles in growing process. Seven o sites were achieved and six m good mature oides we are creo preserved into two straws. So finally from this first and the second stimulation there were 15 all sides creop preserved from for for this lady. Second case study is uh there is there was the 34 IT 34A years old IT specialist. Yeah, there was very good AMH level and high follicical count. There were no healthy condition and she was motivated because um she finished long-term relationship and she wants to proactively pres preserve fertility. We’ve been used the short protocol and with antagonist and we’ve been used 150 units. The ganerix injections and for trigger shot was used the the tripelline. Two times there were done the ultrasound forometries and the oite pickup under general anesthesia was done on day 14. So the re and the result there was there were 19 growing follicles 17 oides achieved and from this after the cleaning of the cells from the oides the 16 M2 oides we are curreserved into four straws. So in conclusion uh let me say that the oite cur preservation by vitrification commonly known as egg freezing is a safe and effective way to preserve the quality of oides for future use in IVF treatment to conceive a child at the right time. Thank you very much for your attention and um your questions are welcome. Sorry, I’m here. I can hear you. Thank you so much indeed for your presentation and also bringing those uh cases because I think that many patients definitely appreciate to be able to see how it work for one patient to to the other. So thank you for bringing this up and now we will go for your questions. So please go ahead type those in. We have definitely some time to answer any of your questions in regards to our topic today. I do see one question but I will give you a little bit more time for them. And uh in the meantime, I do have some questions uh that I would like to ask you before we go ahead with your questions. So basically, of course, you mentioned this before during your presentation, but just to summarize, so how many eggs should be frozen and would one cycle of egg freezing is it enough? One cycle of egg freezing is enough. It’s very individual. Yeah. And uh uh in case that we have no not enough of x if there is no no our goal achieved with the respect the age uh we are we are talking about the next IVF next cycle. So it was in case report described. So we have few patients uh where is where is the the second IVF stimulation needed to collect the the the suitable the the the good good amount of eggs to be to be sure that for the future there will be there will be enough enough of eggs to to de to develop the the the good amount of of embryos. Definitely. Yeah. So, it’s individual and it’s very based on on what your current let’s say um AMH levels and and also entraphollical count etc. Right. So, this is individual. You need to remember that. Okay. And I guess more often it happens that you require at least those two stimulations to obtain um the enough number of eggs as well. I guess right in general in general depending on the on the on on the inclusion include or in incoming AMH level yeah especi which is which is depending on the age of of women so uh uh in general let’s say Mhm. Approximately 50% of of uh okay of woman should to to have the the minimally the second second uh stimulation to collect the uh enough of eggs. Yeah. Yeah. No good. Thank you. Thank you for that. And I know that we’ve we’ve covered this of course topic before and we still receive many many times this question. Is the egg freezing painful? Is the process painful and are there any side effects? So the some procedure of egg collection is is painless because it’s done during under general anesthesia and after the the the procedure yeah the the woman is monitored on the recovery room and if there will be any any pain we can use the painkillers. So um the goal is to to do it uh without the pain. Of course there can be some some symptoms uh with uh connected uh due to the IVF stimulation because the ovaries are enlarged. So there can be some some strange feeling in in the underbelly and uh but all these symptoms are temporary and uh will be especially after the using the trigger shot the the tripeline. So it means after using for the trigger shot the agonists we cannot see at at this time or today we cannot see no ovarian hyper stimulation syndromes. Yeah, that’s it’s it’s a rare rare situations because we are using the the the agonist uh injections for for uh trigger shot. Yeah. Okay. Thank you so much. It’s again important to uh to mention that because many times I think that many women are afraid of the OH HSS but um as you said it’s still it’s something that doesn’t happen too often nowadays so you shouldn’t really and if there was your question was about the complications. Yeah I mean side effects any complications side effects. Yes. So there are some some myths that the the the egg freezing the social freezing can can be dangerous for a regular regular menstrual cycle or there it’s it’s it’s the is the myths. Yeah. It’s the false. Yeah. because the menstrual cycle will will come back to the regularity very very very quickly. Uh uh yeah. So there is a question if there will be all eggs disappeared after the after the IVF after the egg collection. So it’s false. Yeah. So there are there are more and more eggs and uh especially in ladies where is the very poor ovarian reserve the one IVF stimulation cannot cannot uh cost the that the the the eggs will be will be disappeared. Yeah. In total it’s false. Yeah. There is so many misconceptions that that are out there. Of course. So this is something that you shouldn’t worry about, right? Yes. Yes. Yes. Any any other misconceptions that you’ve heard perhaps if we are still on this topic just to uh next about the that is it is dangerous. Yeah, it was it was answered already or or pain painful. So it it was answered. Um so yeah. Perfect. Thank you so much. And if we can also uh just repeat to to everyone about the legal um aspects of age and storage duration when it comes to egg freezing in Czech in Czech. Yeah. So in Czech Republic uh this procedure can be done um until age 49. But uh of course as you you could see in my presentation. So the best age for this procedure should be from 30 till 35 to to be sure that the quality of of of X will be will be good and will be will be optimal to conceive with the genetically normal normal embryos in the in the future. And the yeah and the legal this procedure in Czech Republic is possible to do for for every woman. There is no this procedure is no covered from from healthy insurance and uh so should be should be this proc process should be should be paid u uh from from patient and uh um yeah and uh of course the I was talked about the the 49 age limit but uh after the 35 or after the 40 it’s a bit problematic to do this this process but we can we can do it but for the future before the embryos will be will be used should be recommended to to use the the PGTA procedure to detect what is the genetic what is the genetic profile of of embryos definitely and Actually, you I will ask you this question that we have in the chat. So, at what age? We already explained that, but what age does it make the most sense to freeze the eggs? Is it still worth it at 40? And if if I don’t have a partner, how many eggs should be obtained? So, at 40, let’s say. So, can you answer that question? Uh, I will answer it. I have to to take a help. Yeah. So this this graph yeah there was uh in age 40 there can be the 70% chance to obtain minimally one genetically aloid blastoist if there will be approximately 15 15 eggs collected. So let’s say in age 40 we should to collect minimally 15 15 eggs. Mhm. Yeah. Okay. Helma, thank you so much for your question. I hope that helps. So it’s it’s not uh as you said 35 would be the the preferred kind of age. let’s say up to 35 to be able to um obtain as enough eggs let’s say right so this is definitely an important part yeah yeah yeah so and unfortunately the age uh we have to talk about the age with our patients every day yeah and uh I am very sorry that I have to I have to talk about this because it’s bit sad sensitive issue. Yeah. And uh but the age is crucial and the age in this in our area in our uh reproductive medicine is is the crucial factor. Yeah. That’s why our goal is not only only only the pregnancy. Our goal is the healthy baby in your home and uh it can be it can be done if there are the the genetically normal embryos and and again we are talking about the age. True. So this is this is how it is of course right. So we need to keep that in mind. Uh someone is typing. So I guess we will have some other questions. So please go ahead if there are more questions you know what to do. And in the meantime I would also like to ask you so um are you able to tell us how how often do you see women are um are there any women that are maybe around 20 20ome and they are actually coming or are those ladies who are rather over 30 if you if you were to look at it. So uh the this these ladies between for example between 25 till till 30. This group of patients are it’s very small group. Yeah. And the most of our patients are 35 and more. So 35 35 plus until until 40 and it we this is the most part of of our uh age profile of our patients. Yeah. Yeah. And this is this is how it is. So thank you so much for answering that additional question. We have another um well if you can have a look right in the chat age 43 AMH8 I’m not sure which units uh but AMH8 is is that sufficient this is the question from Hazel and uh the AMH8 it is the question so depending in which units uh was was measured. Yeah. And in my my graph was was the was the AMH levels in nanog per milll in this units it’s very good good ovarian reserve in case especially in UK are measured this antimaran hormone in in um pico mole per milll and uh let’s say it can be on the border of the normal normal range. So depending how which units uh was was used for for this measurement but in case it was in nanog per milll or micrograms per liter it’s very good ovarian reserved the amh8 nanog per milll or 8 pog per liter is is very good. Mhm. Yeah. So that would be sufficient in that case let’s say right. Yes. Yes. Yes. Mhm. Okay. If it’s as you said picomos in UK measurement then no. Right. On on the border. Yeah. And depending what is the age of of of the 43 43 43. Uh yeah it’s can be can be let’s say let’s talk about the the possibility if there is the the interesting to do the the social freezing uh I say yes let’s to do it uh better now than than than ever yeah and it means that uh there can be the possibility to to detect or to have a test for the for the embryos in the future if will be needed or to do the PGTA. But the first step should be to collect the eggs, right? Okay. Thank you. I recommend let’s let’s try it. Yeah, let’s try it. Yeah, in this case, right, you are totally right. Of course, Hazel, if you have any follow-ups and you can share with us uh the measurements, of course, go ahead. You can still do that. And again, I would like to encourage you for more questions. If you have any, go ahead, type those in. Uh and yeah, there is another question just just came here. Um is that rare? Okay, this is the question. Um age 39 to have more than three uploid embryos. Uh, do I have more? Can you see it? It’s Oh, yeah. Yeah, I can. Yeah, I can I can I can see this this question. So, uh I mean I think that uh in this in this depending how many eggs how many eggs uh we’re collected. Yeah. So uh and uh it can be it can be possible uh depending all is dependent on the on the quantity of eggs what is the what is the AMH level so I’m I think that the to collect or to achieve the three embryos uh the three aloid embryos in age 39 is possible. But depending is what is the initial parameter of of antimaran hormone or how many how many eggs can be can be collected. So depending what is the what is the ovarian reserve. Yeah. Yeah. Definitely. And uh there’s there’s I’m just waiting to see if there’s anything else but I don’t see more questions. So we will be slowly finishing. However, I would like to give you a little more time uh for your questions. And in the meantime, can you also tell us so um because I also sometimes heard about the decline about when it comes to egg quality after thawing. Can you tell us a little bit on this? Uh so uh let’s say in the past especially in the past there was there was there was no we we we knows that there was the the eggs are the most fragile cells for the creop preservation. But with the vitrifification techniques uh the survival rate after the unfreezing is about 90 to 95%. So today let’s say for embryos it’s much higher but via vitrification we can we can say that the the survival rate after the unfreezing of eggs is about 90 to 95%. So still high of course. So there’s nothing else. You don’t need to worry about it for sure. Right. So thank you for the clarification. Yeah. Yeah. Okay. I don’t see more questions. So we will be finishing for today. However, I would like to thank everyone for joining us. I do believe it was useful for you and I’m really happy that we are discussing this topic. As we know, as you said, uh women decide to actually go ahead with this after 430. So it’s always good to to discuss it and and spread the word and say that this there are some options available uh for women who want to just preserve their fertility. Right? So any any final words before we finish for today. So uh let me say please don’t hesitate to contact uh any IVF clinics. Yeah. because the cons let’s let’s to do or let’s have a any consultation on IVF clinic and uh you can see what are your possibilities and uh uh is better to to to to discuss about this and if there will be any chance to to do it so please let’s let’s do it definitely thank you so much indeed and remember that if you have any more questions you will be able to simply get in touch with us directly. We’ll be happy to help you out and I’m sure uh Dr. Kokal and his team at Unika um they will be also happy to to hear from you if there are any anything else that you would like to know. So thank you everyone for joining us today. Thank you for your time Dr. Kok and of course I’m really looking forward to some more events with you. It was a pleasure to have you. This is your first event with us. So, I’m really looking forward to some more. And have a lovely evening everyone. Okay, take care. Speak soon. Thank you very much. And have a nice nice evening. Bye. Take care. Bye. Bye. Bye.