Social Freezing
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Social Freezing beschreibt die Möglichkeit, Eizellen aus nicht-medizinischen Gründen, unabhängig von der aktuellen Familienplanung, zu entnehmen und einzufrieren, um sie zu einem späteren Zeitpunkt zur Erfüllung des Kinderwunsches zu verwenden. In den letzten Jahren ist eine deutlich steigende Nachfrage nach dieser Technik zu verzeichnen. Anders als in der häufig verzerrten Berichterstattung handelt es sich bei den PatientInnen vor allem um Frauen, die noch nicht den richtigen Lebenspartner bzw. die richtige Lebenspartnerin gefunden haben und in Kenntnis der biologischen Alterungsprozesse der Eizellen frühzeitig eine Eizellreserve anlegen möchten.
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Die Vitrifikation ermöglicht Frauen die Anlage einer Fruchtbarkeitsreserve, wenn die Verwirklichung des Kinderwunsches erst zu einem späteren Zeitpunkt möglich ist.
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Für die Kryokonservierung von unbefruchteten Eizellen eignet sich das ultraschnelle Einfrieren (Vitrifikation) besonders gut. Im Gegensatz zur herkömmlichen Technik des langsamen Einfrierens entstehen keine Eiskristalle.
Biologischer Hintergrund des Social Freezing
Social Freezing ist eine Möglichkeit für all diejenigen, die die individuelle Familienplanung erst einmal zurückstellen und ggf. zu einem späteren Zeitpunkt weiter verfolgen wollen. Medizinische Gründe, aus denen Eizellen eingefroren werden, sind dagegen der drohende Verlust der Eizellreserve durch Tumorbehandlungen (Chemotherapie, Strahlentherapie) oder bei gynäkologischen Erkrankungen wie Endometriose und frühzeitig verminderter Eierstockreserve. Eine klare Grenzziehung zwischen medizinischen oder nicht-medizinischen Gründen ist somit schwierig.
Eine Verminderung der Fruchtbarkeit ist bereits ab dem 30. Lebensjahr erkennbar; ab dem 35. Lebensjahr nimmt diese sogar exponentiell zu. Dies zeigt sich an der abnehmenden Chance für eine spontane Schwangerschaft pro Zyklus. Ursächlich sind die Verminderung der Eierstockreserve und vor allem zunehmende genetische Fehler der Eizellen. Frauen im Alter von 40 Jahren haben nur noch eine 5 %-Chance auf eine natürliche Schwangerschaft pro Zyklus. Zusätzlich steigen auch die genetischen Risiken (beispielsweise Trisomie 21) sowie die Rate der Fehlgeburten mit zunehmenden Alter.
Die mit dem Begriff Social Freezing gemeinte Erhaltung bzw. Verlängerung und Verlagerung der fruchtbaren Jahre in spätere Lebensabschnitte ist im Übrigen nicht so neu, wie es in der Öffentlichkeit oftmals dargestellt wird. Im Kinderwunsch Centrum München praktizieren wir das Einfrieren von unbefruchteten Eizellen für eine spätere Kinderwunschbehandlung bereits seit 1997 und haben dies bereits mehrere Publikationen zu diesem Thema veröffentlicht.
(z.B. M. Schleyer , W. Würfel, G. Krüsmann, K. Fiedler et al; J Fertil Reprod 2005; 15(2):7-11).
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Die Etablierung der Vitrifikation erlaubt zuverlässige Auftauraten von ca. 88% und Befruchtungsraten von ca. 74% (Potdar et al., 2014). Daraus resultieren je nach Alter der Frau beim Einfrieren Schwangerschaftschancen pro Eizelle von ca. 7%.
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Die individuelle Aufklärung über die Erfolgsaussichten spielt für uns eine große Rolle. Diese können anhand des individuellen Wertes für das Hormon AMH und aus der Follikelreserve im Ultraschall (AFC) abgeschätzt werden.
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Wann ist der optimale Zeitpunkt für Social Freezing?
Da, wie im vorherigen Kapitel ausgearbeitet, die natürliche Schwangerschaftschance bereits etwa ab dem 30. Lebenjahr sinkt, sollte Social Freezing idealerweise möglichst früh durchegführt werden.
Aber selbstverständlich ist eine Behandlung auch noch nach dem 30. Labenjahr möglich.
Wenn eine Frau im Alter von 30-34 Jahren 15 Eizellen einfriert, wird sie mit einer ca. 70%igen Wahrscheinlichkeit mit diesen Zellen mindestens ein Kind bekommen (Doyle et al. 2016). Diese Eizellanzahl wird in dieser Altersgruppe oft im Rahmen einer einzigen Behandlung erreicht.
Behandlungsablauf des Social Freezing
Der Behandlungsablauf ist zum großen Teil identisch mit der Durchführung einer künstlichen Befruchtung (IVF/ICSI), wie sie seit mehr als vier Jahrzehnten angewendet wird.
Ovarielle Stimulation
Zunächst erfolgt die ovarielle Stimulationsbehandlung mit dem follikelstimulierendem Hormon (FSH) und die Eizellentnahme unter Ultraschallkontrolle in Kurznarkose. Im natürlichen Zyklus reifen mehrere Eizellen in den Eierstöcken heran. Lediglich eine davon reift allerdings aus, so dass es auch nur bei einer Eizelle zum Eisprung kommt. Durch die Stimulationsbehandlung werden mehrere Eizellen angereift die anschließend für das Social Freezing verwendet werden können. Wie viele Eizellen dabei den entsprechenden Reifegrad erreichen, ist individuell und abhängig von einer Vielzahl an Faktoren. So beispielsweise von der Dosis der verabreichten Medikamente, der Stimulierbarkeit der Eierstöcke sowie vom Lebensalter. Als Richtwert für das Social Freezing gelten 15 – 20 reife Eizellen.
Die Behandlung erfolgt im sogenannten Antagonistenprotokoll („kurzes Protokoll“) und beginnt am 2. oder 3. Tag der Regelblutung. In der Regel setzen wir ein Depot- Präparat ein, das nach einmaliger Gabe eine Wirkdauer von ca. 7 Tagen hat. Dadurch entfallen zum Großteil die sonst notwendigen täglichen Spritzen. Auf Wunsch kann der Beginn der Blutung ohne Qualitätsverlust durch die Anwendung natürlicher Hormone beeinflusst werden. Dies ermöglicht eine höhere Terminsicherheit. Durch den Wegfall des Embryotransfers ist regelmäßig die Einleitung des Eisprungs durch einen kurz wirksamen GnRH-Agonisten möglich, der das körpereigene Hormon LH freisetzt und für die letzten Reifungsschritte des Follikels nutzt. Hierdurch wird auch das Auftreten des ovariellen Überstimulationssyndroms zur Rarität.
Entnahme der Eizellen
Mittels Follikelpunktion erfolgt anschließend die Eizellentnahme. Dabei werden die Follikel unter vaginaler Ultraschallkontrolle mit einer dünnen Nadel punktiert und die Follikelflüssigkeit sowie die darin enthaltenen Eizellen abgesaugt. Im Labor werden diese direkt auf ihre Anzahl sowie Qualität untersucht und anschließend eingefroren (vitrifiziert). Der Eingriff findet in Kurznarkose statt.
Innerhalb einer Woche nach der Eizellentnahme sind die entstandenen Gelbkörper bereits zurückgebildet und die beginnende Regelblutung markiert den Abschluss der Social Freezing-Behandlung. Auch die Kosten der Behandlung, die von den Krankenkassen nicht übernommen werden, können mit diesem Protokoll relativ niedrig gehalten werden.
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Vitrifikation
Für das Social Freezing wird den entnommenen Eizellen durch Zugabe einer speziellen Lösung das Wasser entzogen. Die Eizellen werden dann mittels flüssigem Stickstoff vitrifiziert (ultraschnell eingefroren). So wird verhindert, dass sich innerhalb der Zellen Eiskristalle bilden und diese zerstören. Durch die Vitrifikation werden physikalische Prozesse in der Zelle, wie beispielsweise Alterungsprozesse, aufgehalten und können in Kryobehältern über Jahrzehnte hinweg gelagert werden. Mehr zum Ablauf des Social Freezing erfahren Sie hier.
Rechtlicher Hintergrund
Für Social Freezing Behandlung gibt es keine Einschränkungen von gesetzlicher Seite in Deutschland. Es können sowohl unbefruchtete Eizellen als auch Eizellen im Vorkernstadium, also nach dem Eindringen der Samenzelle in die Eizelle vor der Verschmelzung der Erbanlagen, kryokonserviert werden. Ebenfalls lassen sich Eierstockgewebe sowie Samenzellen eingefrieren. Allerdings mit der Einschränkung, dass diese ausschließlich für den Eigenbedarf verwendet werden. Die Eizellspende ist in Deutschland derzeit nicht erlaubt.
Kosten des Social Freezing
Die Kosten für das Social Freezing orientieren sich an der Anzahl der Behandlungszyklen. Wie viele dieser jeweils notwendig sind, hängt von der individuellen Eizellreserve ab. Leider übernehmen zum aktuellen weder private noch gesetzliche Krankenkassen die Kosten der Behandlung. Damit Sie sich vor einer geplanten Behandlung bereits einen transparenten Einblick über die Kosten machen können, erstellen wir im Kinderwunsch Centrum München gerne einen individuellen Kostenplan für Sie.
Risiken des Social Freezing
Grundzätzlich bringt das Social Freezing kein Risiko für die Gesundheit der PatientInnen. Generell ist jedoch festzuhalten, dass eine Schwangerschaft im höheren Alter prinzipiell mit einem größerem Risiko für Komplikationen verbunden und für den Körper durchwegs anstrengender ist als im jungen Alter. Zudem müssen beim Social Freezing mehrere Eibläschen gleichzeitig in den Eierstöcken reifen. Dafür ist eine künstliche homonelle Stimulation, welche mit Nebenwirkungen einher geht, notwendig. So kann es etwa zu Hitzwallungen, Schwindelgefühl oder Sehstörungen kommen.
Wir vom Kinderwunsch Centrum München unterstützen Sie umfassend auf Ihrem Weg der Familienplanung. Gerne berät Sie unser erfahrenes Praxisteam in allen Fragen rund um das Thema Social Freezing.
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Da die Eizelle für weniger als 24 Stunden befruchtungsfähig ist, ist der optimale Zeitpunkt für Geschlechtsverkehr ein bis zwei Tage vor dem Eisprung.
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Weiterführende Links
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– Kryokonservierung von Embryonen
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Eine künstliche Befruchtung mit Vereinigung von Eizellen und Spermien außerhalb des weiblichen Körpers kommt zum Einsatz, wenn einfachere Therapieansätze wenig Aussicht auf Erfolg bieten. Moderne Therapieprotokolle erlauben eine individualisierte Behandlung.
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Durch einfache Blut-und Ultraschalluntersuchungen kann bei Frauen ab Anfang 30 eine Einschätzung der Fruchtbarkeitsreserve erfolgen. Unter den hormonellen Parametern ist die Höhe des Wertes für das Anti-Müller-Hormon (AMH) am aussagekräftigsten.
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Unerfüllter Kinderwunsch bei Frauen mit 40 plus ist eine besondere Herausforderung. Die Untersuchung aller relevanten Aspekte sollte koordiniert erfolgen, um nicht wertvolle Zeit zu verlieren.
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