Freezing eggs, embryos, and sperm has always been an important part of infertility treatment. Those who chose to do IVF, had to pause conception due to health issues, or those who simply wanted to wait to start their families often pursued storage options. Despite having to pause numerous treatments due to the COVID-19 Pandemic, egg retrievals, sperm collection, and other freezing options continued to be take place. Because of this, questions around storing eggs, sperm, and embryos have been common, so Dr. Scot Hutchison took to Facebook Live to answer patients’ questions.
Thank you for joining us on this Hutchison’s Huddle. Today’s topic is about egg and sperm and embryo storage during COVID-19.
So many of you have been probably following this story and trying to think about getting pregnant here. I will tell you that if you look at the ASRM.org recommendations, they updated those on the 24th and they kind of create quite a bit of wiggle room, the way I interpret it. So there’s a little bit of talking out of both sides of their mouth with it. On the one hand, they will say you really shouldn’t do any treatment until you have had 14 days in your community of declining COVID cases. On the other hand, they say, well, there’s regional differences and if you have a particular region that is where the hospitals are not overwhelmed, and certainly right now in Tucson, it appears that they are not with ICU patients, then maybe you can go ahead. They also say that a lot depends on the patient. And they give some pros and they give some cons. Clearly, the worst case scenario is that if we have a big secondary wave, and then you’re pregnant, and you have either a tubal pregnancy, which would be a 1 to 2% risk, or a miscarriage, which is give or take depending on your age, range from 10% to about 50% and you might need a DNC, then that puts you at risk of getting the disease if you have to go into the emergency room or the operating room. And then also, we would be overwhelming the hospitals potentially, and having to divert care away from people to take care of you, or maybe you don’t get taken care of. So, those are all factors, I think, that people need to weigh in there. Certainly, we are doing retrievals and banking people’s embryos and eggs going forward. As far as with transfer, I think really that depends on the individual patient and what their circumstances are. With us not knowing really what the COVID virus does to babies and to pregnant women, so far, it doesn’t seem to be as bad as it was looking originally.
So there was a list of questions. For those whose treatments have been on hold due to COVID, they might be wondering about the storage of the eggs, sperm, and embryos. First, how long are eggs, sperm, and embryos typically stored? Well, they can be stored basically forever. The thought is that in liquid nitrogen, they are essentially, you know, they’re vitrified, they’re turned into glass, basically, at least the embryos and the eggs. There’s really no molecular motion, so the thought is that it could be thousands of years that these embryos and eggs and sperm are good for. Eventually cosmic radiation, which basically can penetrate through anything even, you know, in small amounts, thick lead vessels will get some radiation through, that would damage the DNA of the eggs, sperm, and embryos. But for the short term foreseeable future, there’s really no damage to keeping them frozen.
Another question is if there are less people in the office, how are you making sure that the eggs and sperm and embryos are safe? Well, the office is locked, obviously, it has alarms .The tanks that all of these tissues are stored in, also have locks and individual alarms. And so those, we feel fairly confident that is good protection now. If there’s, you know, an army that wants to come rolling through to create all kinds of havoc, potentially. could be an issue, but I don’t anticipate that.
People have said how does the freezing technique and the process change over time? So, traditionally, we know that when you freeze a tissue, you create ice crystals and the ice crystal crystals will expand and they’ll actually rupture the cells. And so that’s why, traditionally, frozen meat or frozen fish has not tasted quite as good as fish that is freshly caught and eaten or meat that’s fresh. But the process at least for initially freezing embryos which started about, you know, 25ish years ago was to try to de-water the embryos. So try to take as much water out of the embryos as you could. And then there were slow freeze techniques and then rapid freeze techniques. And then over time, the more rapid freeze technique was thought to be better. And then some investigators figured out that you know, especially looking at some of these animals that can actually be frozen solid in the Arctic tundra, especially these frogs that essentially arrest all metabolic activity and are basically frozen, they have a cellular antifreeze and that keeps them from forming those crystals. So that was sort of the next big step was to go to figuring out how to add that antifreeze into the surrounding areas and not just de-watering, trying to get that antifreeze basically in there so that you could turn those embryos into a solid, you know not an icicle, but basically a solid like glass, hence the term vitrification. So that is the current standard of care for that for eggs and embryos.
And then someone says, what is the thawing process for egg sperm and embryos? And that is surprisingly simple. You can just warm them up in a controlled fashion and, like, a sperm sample can be good to go within 10 minutes. The others–embryos we typically like to watch after we’ve thawed them for a few hours, to see that they start re-expanding, which means that the cellular pumps within the embryo have turned back on and are working well. So that we know that the embryo actually survived the thawing is alive.
There’s a comment, my fresh and frozen honey bunnies are now 13 and 17. Oh, that’s heartwarming. Yeah. It’s so cool. For us, it’s so cool because, you know, the majority of embryo transfers are frozen embryo transfers. And the reason for that is that fresh embryo transfers, if you’re transferring the same time as the IVF cycle, the same cycle, the hormonal changes to make all those extra eggs around, affect the uterine lining in a bad way. So they tend to cause the uterine lining to not allow for as deep or as broad of implantation from the placenta. So that is what we do mostly frozen embryo transfers now. So, and some laboratory models were able to show in animals how that happens. But fresh embryo transfers, long story short, cut about two to three weeks off of the duration of the pregnancy, so they increase the risk of preterm delivery. So, that’s why we do frozen embryo transfers. But historically, you know, we’ve had several patients who had–and I think we were up to three–who had four kids apiece, separate pregnancies, off of one egg retrieval. And so it’s always interesting to see these kids come in, you know, you see these stair step kids of different ages, but they all basically were from–they were all the embryos all sort of created at the same time. And so they’re kind of sort of each other’s age and sort of not. So that’s pretty cool.
And what else in here? There’s a patient who says, I’m not currently a patient at RHC–that’s here–but I’m thinking of switching after COVID-19. How would I go about transferring embryos to the clinic? That’s very easy. Just give us a call and we’ll arrange that. That’s not a big problem. Embryos get transferred all over the country, same with sperm samples, eggs. You’ll see the FedEx tanks back in our lab area, and then the empties that are ready for FedEx to be picked up practically every day. So there’s pretty standard stuff these days.
So I’ve heard recently, like my cohort Karina here who helps me with this, is very friendly and so people will confide in things to her and then their other staff, that they don’t to me. So I guess I’m not as warm and fuzzy, or they feel embarrassed or whatever. So, I just wanted to tell you if you’re not being compliant with something, you can tell me about it, and especially if it’s something like Metformin that’s bothering you, feel free to tell us, we’ll try to troubleshoot it with you as best we can. And we will not judge you if you don’t take your vitamins or whatever, but we do want to try to troubleshoot it out to where we can get you tolerating things, if at all possible.
So, and again, let me just put in a plug here during this COVID time, it’s stressful for people. I’ve certainly seen my waistline kind of expanding, which is, I’m sure, due to the potato chips which I should not eat, and the popcorn, which I should not butter as heavily. But other things like–I had a patient here today who had lost a bunch of weight because I think just because of the stress of the whole situation. So please be careful with that. We want you to not be drinking alcohol, not smoking pot, not eating junk food because all these things are really, really bad for your fertility. You know, if you feel like you need counseling, I would strongly recommend that you do that by televisit or phone visit. And I think there are so many good counselors who are really adept at that. Because we do want you to sleep really well and we want you to kind of get control of your anxiety.
I think things are gonna work out. I’m far less anxious about this whole COVID thing with regard to fertility patients than I was a month or two ago. I think that in the end, we’ll get a handle on it. And I think that it’ll be kind of a hiccup of six months or a year, whatever, that people have had their plan sort of put aside, but I think we’ll eventually get on it. And so in the meantime, let’s try to get our eggs and sperm as good as they can be for trying to get pregnant.
So if anyone else has any questions, please feel free. You can chirp into these things right here or later on, you can send them to us as well. And feel free to look at our other archived Huddles. A couple weeks ago we had a really good one with different patients. There were a few different couples who all have different fertility journeys and I think those are always interesting for people to see, kind of eye opening because not everybody has the same issues with trying to get pregnant.
There was another question. Is there a chance that COVID-19 can affect sperm, eggs and embryos in the lab? The answer to that is really no. Once things are frozen, other things can’t really get in there. The freeze containers for these tissues are different. The sperm are inch long little vials, those are then clipped into what are called canes and then those are immersed in liquid nitrogen after freeze. And then the embryos are actually in what’s called a straw or these little–they look like a large plastic cocktail stirrer, is kind of the way I would describe it. But they’re kind of like a vault and the embryo goes in and there’s a top that slides over and then those are able to be then effectively protected and then stored as well. And there’s just no way that any of these viruses could jump out of the liquid nitrogen, if they could survive that, and then get into these other containers. So I don’t think that that’s really a thing. That FDA, I think has always been a little bit more over the top with, like saying, Oh, you know, like people with HIV who have embryos, those embryos should be stored in a different facility and they should not be stored in a tank where people don’t have HIV, this but again, how that HIV is going to jump out of one container, swim across the liquid nitrogen, and get into another would be a real mystery to me. And I think pretty unlikely.
Anyway, if you have any other questions please feel free to give us a holler and we will look forward to talking with you and have a great night.