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Cryopreservation refers to the storage of a living organism at ultra- low-temperature such that it can be revived and restored to the same living state as before it was stored.
Embryo Cryopreservation (Freezing)
Embryo cryopreservation (the process of freezing, storage and thawing embryos) can enhance pregnancy rates by allowing excess embryos not replaced in a fresh embryo transfer to be stored for future use.
Embryo freezing may also be performed when a fresh embryo transfer is not performed for any of the following reasons : -
Risk of ovarian hyperstimulation syndrome,
Poor quality endometrium (a thin uterine lining),
Intermenstrual bleeding,
Planned “banking” cycle in which the patient elects to store all embryos,
Extremely difficult embryo transfer.
Embryos are placed into straws or vials containing anti-freeze or cryoprotectant solutions. These are transferred to a programmable biological freezer which is used to achieve a controlled slow rate of cooling. During cooling, cells dehydrate and as the temperature is reduced, more ice forms and water is removed gradually from the cells. Slow cooling is continued to ~ -35°C at which point embryos are rapidly cooled by plunging into liquid nitrogen (-196°C). Embryos are kept in storage tanks of liquid nitrogen until thawing is performed.
Semen Cryopreservation
Semen freezing is useful for men who find it difficult to ejaculate on demand which may result in their inability to produce a sample on the day of egg collection.
Sperm from two sources can be frozen: from ejaculates or from fluid extracted in the operating room during surgical procedures (vasal, epididymal and testicular sperm specimens). The sperm is usually frozen for a period of one year; at that time, future arrangements are discussed. It is generally believed that sperm that have been through the freeze-thaw process are no more likely to result in birth defects than freshly ejaculated sperm.
The advent and development of ovarian cryopreservation and transplantation technologies
The cryopreservation of ovarian tissue is a technique which was developed in order to bank oocytes to counter the loss of all viable eggs following a medical treatment, disease or through the aging process. Ovarian cryopreservation may be used to restore fertility and normal ovarian hormone production without the need for hormone replacement therapy (HRT). The first reported development of this technique was only a decade ago (Gosden et al., 1994), but interest in this new technology is growing rapidly.
A number of medical conditions, other than the aging process threaten to destroy all the viable eggs within a woman’s ovaries. These include ovarian cancer, and the loss of eggs through chemotherapy or radiation treatment. Whilst sperm production in men is continuous throughout life, it is commonly accepted that women are born with a fixed number of eggs which will in part determine their reproductive lifespan. Any treatment that accelerates the loss of eggs may hasten the onset of the menopause.
Whilst the cryopreservation of sperm is a technology which has been in use for decades, the development of ovarian cryopreservation technology has been hampered by difficulties in conserving the cytoplasmic and nuclear integrity of unfertilized oocytes (eggs) during the freeze-thaw process, cells which are notoriously perishable. With the advent of assisted reproductive technologies such as IVF, egg or embryo freezing became possible, as eggs could be harvested following hormonal treatment at specific times of the menstrual cycle. By this means excess eggs may be collected for later use (egg banking), which particularly benefits those women who delay child-bearing until their late thirties or beyond.
How is Egg Cryopreservation Done?
Freezing eggs is a rather involved process. First, you are given injectable fertility drugs (gonadotropins) daily to stimulate your egg production. Just before you are set to ovulate, your eggs will be retrieved in the same type of procedure that is used for IVF. Once the eggs have been harvested, they will be frozen with liquid nitrogen and stored in special freezers until you decide to use them. A newer technique that is still being tested involves flash-freezing the eggs.
While the majority of the process is still the same, your eggs are instantly frozen rather than slowly frozen. The main benefit to this process is that it avoids the formation of ice crystals. As a result, the eggs can be thawed with virtually no damage done to them thus improving your chances of conceiving and having a successful pregnancy. However, flash-freezing eggs has been shown to make conception through IVF more difficult. Therefore, it is often necessary to use ICSI in order to fertilize the egg.
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