EEF or IVF: Key Factors to Consider for Later Pregnancy

Women today focus more on education, careers, and financial independence before starting a family, so the decision to have children is often delayed. This shift in family planning has led to an increased use of assisted reproductive technologies like EEF and IVF.

Medically, although they are similar protocols that involve stimulating the ovaries and then followed by egg collection, Dr Yeong advised that the context in which EEF and IVF should be advised to patients is different.

“Elective egg freezing, as the name suggests, is social egg freezing; primarily, it's meant for younger women who haven't had a partner or are not ready to settle down with their partner, let alone starting with family. It is the most common reason for doing elective egg freezing and trying to do some form of fertility preservation,” he added.

Essentially, egg freezing offers 'eggsurance' for family planning, providing more time and freedom to make thoughtful life and relationship choices instead of rushing into a 'panic-coupling' situation.

“Societal pressures, age-related fertility concerns, or the biological reality of declining fertility with age often drive this anxiety,” he explained.

IVF treatment, on the other hand, is limited to legally married couples and could be the right choice for couples ready to start a family.

However, the two approaches have unique values and distinct merits. When deciding between EEF and IVF, it's essential to carefully weigh the key factors that can affect the chances of a successful later-life pregnancy.

Egg Quality and Quantity

A key distinction between EEF and IVF lies in how they address the natural decline in a woman's egg quality and quantity with age.

The goal of egg freezing is to extract and cryopreserve a woman's healthiest, most viable eggs when she is younger, typically in her 20s or early 30s. The optimal number of eggs to freeze will depend on the woman’s age at the time of collection, as this influences fertilization, chromosomal abnormalities, and, therefore, live birth rates.

These frozen eggs can then be thawed and used for IVF when the woman is ready to conceive. The advantage here is that the eggs are "locked in" at a younger age before the natural age-related decline sets in. Hence, in many countries, the age limit is less than 37 years old, where success is better for frozen eggs,” Dr Yeong said.  

In contrast, IVF uses the eggs a woman has at the time of treatment, regardless of her age. While fertility medications can stimulate the ovaries and produce multiple eggs for retrieval, the overall egg quality will still be impacted by the woman's current age.

The takeaway is that EEF offers a way to essentially "pause" egg quality decline with age, whereas IVF requires working with a woman’s eggs now. For women hoping to conceive later in life, EEF may provide a distinct advantage over IVF regarding egg health preservation.

Pregnancy Rates and Outcomes

Maternal age is the critical factor influencing pregnancy rates and outcomes for egg freezing/extraction and in vitro fertilization.

The percentage of embryo transfers that result in a live birth is around 40% for women aged 32. At ages 37, 40, and 42, this decreases to 35%, 25%, and 15%, respectively.

The advantage of EEF is that women can bank multiple eggs when they are younger, preserving a "reserve" of healthier, genetically competent eggs. Compared to using eggs retrieved at an older age, this method offers a higher cumulative chance of a live birth over multiple transfer cycles and better survival during the thawing stage. It reduces the baby’s risk of chromosomal abnormalities, such as Down syndrome, premature birth, low birth weight, and miscarriage.

However, age-related health risks don’t just affect the baby; they also impact the mother.

“As maternal age rises, so do risks of conditions like hypertension, diabetes, and asthma, which can impact both the pregnancy and the mother’s health,” Dr. Yeong noted.

Overall, EEF and IVF provide viable pathways to pregnancy. Though there were concerns about the safety and efficacy of using frozen eggs with regards to pregnancy, the health of the baby, and long-term child development, with medical improvements, EEF is now considered a safe and effective option for women who want to preserve their fertility due to age, so long as they receive proper counseling.

Still, the pregnancy outcomes depend heavily on the woman’s age, the number and quality of available eggs or embryos, and, to some extent, the partner's age.

"Research indicates that as men age, particularly beyond 45, the incidence of DNA damage affecting sperm quality increases," Dr. Yeong added. "This is why many sperm donor banks have an upper age limit for donors, as advanced paternal age can impact reproductive outcomes."

Practical and Emotional Considerations

A key practical consideration regarding elective egg freezing is its cost. This includes the egg freezing cycle fees, storing frozen eggs based on the number of mature eggs collected, and annual storage fees. In Singapore, the EEF procedure is entirely paid for by the individual, with no subsidy. With scientific advancements continuing and health policies evolving to address the country's declining fertility rates, the affordability of EEF may improve in the future.

While egg freezing does not guarantee a future pregnancy, it is often framed as an integral aspect of women's reproductive rights in that it allows women to preserve their fertility potential, giving them more control over their fertility timeline and future family planning.

Dr. Yeong explained, "It's an issue of autonomy and women's rights. A marriage certificate is required in Singapore for IVF, while a civil agreement may suffice in other countries."

In terms of time commitment, IVF typically involves more intensive planning and procedures, such as multiple clinic visits and treatments timed around the menstrual cycle. While egg freezing also requires several appointments, it tends to be less disruptive to daily routine.

Although retrieving and freezing eggs can be emotionally and physically demanding, EEF is an investment in family planning possibilities. IVF, on the other hand, is more focused on achieving pregnancy, offering a more direct path to parenthood. Despite its challenges, including hormonal treatments and invasive procedures, many couples find the IVF process deeply fulfilling and engaging as they move closer to their goal.

Ultimately, choosing EEF over IVF and vice versa is a personal choice. Factors like readiness to conceive, relationship dynamics, physical health, financial considerations, and emotional preparedness for the journey should be considered. Therefore, consulting with a fertility specialist for advice based on unique circumstances and family goals is essential for making the right choice.

The article first appear in Healthcare Business Today, Dec 4, 2024 - https://www.healthcarebusinesstoday.com/eef-vs-ivf-factors-later-pregnancy/