Today, it is technically possible to freeze and store egg cells, sperm cells, and embryos for many years and to use them when a baby is desired. While embryos can legally be frozen and stored in IVF treatments, lifting the restrictions on freezing eggs and sperm could open a new era in treatments.

Developments in IVF treatments continue to produce encouraging results. Both in the world and in our country, these treatments now have a considerable history, and prejudices about them are slowly disappearing. Op. Dr. Kaan Bozkurt, who has worked in the field of IVF for 16 years, says: “The questions asked in those years are very different from the questions asked now. In the early years of IVF, people were not sure whether the baby was created with their own egg and sperm. Now very few people ask that. Also, people thought that everyone would get pregnant under all circumstances with IVF. It is now known that repeated attempts may be necessary. Not getting a result after one IVF attempt does not mean that you will never get a result. Likewise, becoming pregnant once with IVF does not mean that you will become pregnant the next time with the same method.” We spoke with him, from İRENBE Women's Health and Obstetrics Center, about the freezing of reproductive cells and the innovations this process brings.

What is the situation regarding IVF in Türkiye in numbers?

According to official figures, 42,000 IVF procedures are performed annually in Türkiye. In a country with a population of 80 million, the annual need for IVF treatments is between 80,000 and 100,000. This means that only about half of the people who need IVF treatment in Türkiye are able to receive it.

Why can only half of the people who need IVF still access treatment in our country?

The distribution of centers is an important factor. Mostly, Istanbul, Izmir, Ankara, Antalya, and Bursa are prominent. Even if there are centers elsewhere, some people still think, “I hope nobody finds out.” There is also still the prejudice that “this can only be done properly in big cities.” State support for treatment costs is also very low. In many European countries, the state supports IVF 5–6 times or until a child is born. In our country, the state covers only a small part of the cost and only twice. Despite this, Türkiye ranks 6th in Europe and among the top 10 in the world in IVF procedures.

What is the live birth rate from IVF treatments in Türkiye?

Around 1.5 million IVF procedures are performed annually in the world, and approximately 400,000 live births occur. Türkiye’s rate is slightly above this. We are a successful country in IVF. Conferences and scientific publications confirm this.

Freezing sperm and eggs can still only be done under certain conditions in our country, right?

Yes. You cannot freeze sperm or eggs simply for future use. This is a serious problem, especially for women. For example, imagine I am a woman, I am 35 years old, and I am not married, or I am married but do not want children yet. I am at risk of losing my eggs in the future. Can I freeze my eggs? No, it is prohibited. Technically, storing eggs or sperm is possible, but it is forbidden.

Being a Woman Is Also a Disadvantage!

Under what conditions are sperm and egg cells frozen?

There is no regulation for preserving eggs simply because a woman wants to freeze them for future use. A woman cannot legally apply to an IVF center and say, “I want to freeze my eggs now so that I can use them later.”

For men, sperm can be stored if there is a disease or treatment that may reduce the sperm count to zero.

How can egg cells be frozen in women if there is no regulation?

For married couples, a woman’s egg cells can be frozen to be used by the couple themselves if necessary. However, it must be documented that this is necessary. For example, if the woman’s ovary will be removed, if she will undergo surgery, or if she will receive chemotherapy, and if she provides documents proving that these treatments will render the ovaries nonfunctional, then, if she is married, her eggs can be frozen. Even though this is not clearly written in the regulations, it is not considered a crime. However, an unmarried woman, or a married woman who says, “I do not want children right now,” cannot legally freeze her eggs at the moment.

Being a woman seems to be a disadvantage here as well...

Being a woman is always a disadvantage. It appears in IVF as well. Let us say you prohibit sperm and egg donation for some reason. There may be other countries with similar prohibitions. This is open to debate. The Ministry of Health says this is to protect family lineage and to know whose child belongs to whom. These reasons may be valid or debatable. But why prohibit the freezing and storage of your own sperm or egg cells for your own future use? There is no justification for this.

Do women ask for their egg cells to be frozen?

Of course they do. Even though the subject is not yet widely known... If it were, every woman who postpones or has to postpone having children would want it. And not only women without children — a woman who wants to have her second child at a later date would also want her eggs frozen. Therefore, women need to demand a legal regulation. In fact, not only women of a certain age without children, but all women need egg freezing. Even at the age of 25, you cannot know what fate has in store for you. Freezing and storing reproductive cells while healthy protects a person from many possible risks.

It Is Possible to Give Birth at the Age of 55!

As women age, the decrease in egg reserve is an important factor, isn’t it?

As women age, the quality of their eggs decreases. After the age of 40, the decrease in both the number and quality of eggs accelerates significantly. In IVF treatment, after the age of 43–44, the pregnancy rate falls to zero. There are exceptions, but statistics cannot be based on them. It is assumed that at the age of 44, the chance of pregnancy with IVF falls to zero.

Let us say a woman’s egg cells were stored. For how long can the woman’s body carry a pregnancy in a healthy way?

If the woman has no other health problems and no systemic disease that threatens her own health and therefore pregnancy, she can even give birth at the age of 55. If pregnancy is achieved at the age of 45–50, especially if the eggs were stored when she was younger, the risk of chromosomal abnormalities also disappears.

Are there restrictions on embryo freezing?

There are very few restrictions on embryo freezing, and it provides great convenience in practice. The fact that embryos can be frozen and stored has brought great relief to IVF practice. We can reduce the risk of multiple pregnancies because we can freeze embryos and transfer them one by one in small numbers. By collecting eggs from a woman once, you may have the chance to transfer embryos 3–4 times. Costs are also reduced. Embryo freezing options improve both comfort and quality in IVF while reducing costs.

Is there a difference between fresh and frozen embryos?

The quality of freezing has reached such a high level that pregnancy rates are the same as with fresh embryos. In fact, sometimes higher success rates can be achieved than with fresh embryo transfer.

Why?

Because in frozen embryo transfer, the uterine environment into which the embryo is placed is closer to its natural state. The effects of ovarian stimulation and egg retrieval have already passed.

Inside Liquid Nitrogen

In what environment and for how many years can these frozen cells be stored?

Whether it is sperm, eggs, or embryos, the important moments are when they are frozen and when they are thawed; these determine whether the cells will be damaged and whether they will work later. Apart from the freezing and thawing process in liquid nitrogen, the fact that they remain stored for 5, 10, or 15 years has no effect on the result. A frozen cell can remain in liquid nitrogen at -195 degrees for years. In Türkiye, the legal limit is 5 years. However, this period is not a scientifically determined limit. Years ago, it was even a headline in Yeni Asır. A patient who brought sperm that had been frozen 14 years earlier in France was able to have a child in Izmir through IVF. Thus, we saw that IVF could be performed with sperm that had been frozen for 14 years. There is no scientific limit to this period. These cells are stored in a tank containing liquid nitrogen. According to regulations, IVF laboratories have a freezing section, and frozen cells are stored there. Scientifically, however, that tank can be stored anywhere as long as the liquid does not leak. You could even keep a liquid nitrogen tank at home with its lid closed. The important thing is that the liquid nitrogen inside the tank does not run out, because it evaporates and disappears over time. The liquid nitrogen must be replenished so that the cells do not thaw.