How to freeze your eggs in Pakistan

There is a specific flavour of panic that colours the existence of the Pakistani woman. It develops as she becomes cognizant of society’s Three Holy Ms: Money, Marriage, and Motherhood, all three for which she is expected to stick a landing within a tyrannically slim opening in time.

One of them, *Rubab Shahid, had spent what some would call her biologically prime years, focusing on the M of her own damn choosing: Money. She went full throttle on her career and like other women, mused that marriage would eventually find its place in the grand scheme of her things.

Fast forward to her year 37. Rubab was a boss lady at work, but her relationship status still checked the single box on intrusive government forms. She had navigated a mediocrity-soaked dating pool into her early 30s but had not come close to finding someone who wouldn’t make her grind her teeth at night. It became clear then that time waits for no man, and certainly no husband. By 38, she had resolved to preserve her fertility.

In 2020, she booked her first consultation with one of Pakistan’s well-known In-Vitro Fertilisation (IVF) specialists, who also happened to be her mother’s friend. “Oh my God, if you do this, you will delay marriage even more,” he oozed. “We can freeze your eggs, but why now? You’re still young. Find a guy!” He did not supplement his moral prescription with clinical investigation.

Rubab’s foray into reproductive autonomy explains one of the reasons why few women take this route.

To separate the science from the judgment and demystify the process of cryogenic baby-making, we spoke to Dr Nida Najmi, an Assistant Professor of Obstetrics and Gynaecology at Aga Khan University. She has worked at St. Bartholomew’s Hospital in London and is setting up an IVF clinic at AKU.

If you or your partner are exploring viable options down the line, or simply curious about how the process works, this is a rough guide to freezing your eggs in Pakistan.

Phase 1: Patient selection and consultation

The first stage is all about figuring out if egg freezing actually makes sense for you and your body. The doctor will look at your overall health, medical history, and, the big one, your age. It is the primary factor that dictates both quantity and quality of your eggs. If you’re between 25 and 40 years of age, you’re in the sweet spot. (This isn’t to say you cannot freeze your eggs if you’re past 40 but undergoing the procedure at the time has historically yielded little clinical benefit.)

During this chat, you and your OBGYN will narrow down your why. This falls into one of the two camps. The first is social, wherein a woman elects to delay pregnancy to focus on education, career development, or life goals. The second, and a much more common one, is medical. Women preserve fertility prior to treatments or due to conditions that damage ovarian reserve. This could be, for example, a cancer diagnosis, in which case immediate egg freezing must take place before the woman starts chemotherapy, which heavily impairs fertility. Endometriosis is another condition that degrades egg quality and ovarian function over time. Catching this early (say in your 20s) and freezing eggs will protect your options before the condition worsens.

Once you’ve discussed your case and are green-lit, you will give formal consent and prepare for the upcoming cycle.

Phase 2: Protocol briefing and the waiting game

The timeline of the actual procedure is synchronized with your menstrual cycle. The team will chart your medication schedule designed to prevent premature ovulation and stimulate your ovaries to produce multiple egg-containing follicles (fluid-filled sac where an egg lives while it matures). Then, you wait for your period. As soon as it arrives, you call the fertility clinic for a heads-up. That first day of menstrual bleeding is “Day 1” of the countdown, setting the baseline for everything that comes next.

Phase 3: Ovarian stimulation

For a young, healthy patient, this phase takes about two weeks (12-14 days) and looks a lot like the first half of a standard IVF cycle.

On day 2 or 3 of your period, you’ll head to the clinic for a transvaginal ultrasound. If the scan shows your ovaries are ready, the cycle is cleared to begin.

You will start receiving your daily hormone injections. For that, you can either pop into the hospital or clinic or self-inject at home (it’s a tiny needle, like an insulin pen’s). You’ll be given two types of medications: one to temporarily control your body’s hormones so you don’t release an egg too early, and another to nudge your ovaries into growing multiple egg-containing follicles.

Since you will be receiving high doses of hormones, your body must be monitored to prevent complications such as ovarian hyperstimulation (overdose). Every alternate day, you’ll head back to the clinic for a two-part check-up. Internal ultrasounds will be conducted to measure how the follicles are responding and growing, followed by blood tests to keep an eye on your hormone levels so they don’t spike out of control.

Based on those results, the doctor will adjust your daily dosages, bumping them up or dialing them back, until your follicles hit the size they need to be. The ideal follicle size for conceiving is between 18mm and 24mm in mean diameter.

Once the follicles are sufficiently large, you’ll be scheduled for a minor........

© Dawn Prism