Should You Put Your Eggs On Ice?
Make coffee. Wash face. Brush teeth. Shoot hormones cloned from Chinese hamster ovaries into my belly,” – that’s how New York based author Rachel Lehmann-Haupt describes the first days of the egg freezing in her book In Her Own Sweet Time: Unexpected Adventures in Finding Love Commitment and Motherhood (Dhs55, amazon.com). “I was 37 and had just broken up with my boyfriend, biologically it was really bad timing. I wanted kids but time was running out and I just didn’t want to put that pressure on myself or the men I was dating,” she says. “Ideally I’d like to use my eggs when I meet Mr Right, but I also don’t want to be a new mum at 47-48. If I don’t meet him I’ll consider donor sperm. Life’s timelines don’t always go as planned, so I figure why not make your own timeline?”
To do so, first you’ll have to inject or inhale hormones to stop your normal menstrual cycle. Then you’ll deliver daily injections that stimulate your ovaries to overproduce eggs. Once enough mature eggs are produced (normally after 2-5 weeks), you’re sedated, these are removed, frozen and stored in liquid nitrogen where they can stay, in most cases, for a maximum of 10 years. Hopefully before then you’re ready for a baby. They’re then thawed, sperm (from Mr Right or Mr Donor) is injected into them using the same process as in IVF and an embryo implanted into the womb – and bingo, one baby. It sounds like the answer to the prayers of thousands of childless women. But is it really as simple as all that? Not quite.
Official figures state that only around 900 babies have been born worldwide from frozen eggs, even though the treatment has been around in some form since 1986. In the UK, more than 6,000 eggs are stored, around 150 embryos have so far been created, but only five babies came of those – although two more have been born since those figures were produced. In the US, 857 eggs have been thawed resulting in 337 births – a success rate of 39.3 per cent. “I can’t tell any of the women who come to me that there’s a guarantee that they will get a baby at the end of things – it’s not like fire insurance, it’s not always going to pay out,” says Dr Gillian Lockwood, from the UK-based clinic Midland Fertility Services who can claim the credit for those seven UK babies. “But what I can tell you is that the technology is improving dramatically and we can now say that using an egg frozen from a woman in her early 30s will give us the same chance of success as IVF using a fresh egg in a woman of that age.” In fact, while old figures used to say the chance of an individual frozen egg producing a baby was about four per cent, some of the latest figures are showing better results. A 2010 paper reporting on a trial at the US clinic Reproductive Medicine Associates of New Jersey looked at pregnancy rates in 21 ‘fertile’ women using eggs frozen for six months. Of these, 13 ended up with a baby and the chance per egg retrieved of successful live birth was 5.1 per cent. Back in 2009, the Dubai Gynaecology and Fertility Centre (who started to offer egg freezing in 2008) reported that all four women of the women they had so far implanted with frozen eggs were pregnant and one had just given birth.
The reason for the rise in success is that the technology in egg freezing has improved. The old process used to slowly freeze the eggs which could cause ice crystals to form within them and damage them. Now they’re frozen rapidly and the crystals don’t form. “This process, called vitrification, has improved success rates dramatically, plus we’re getting better and better at IVF, which maximises the chance of getting women pregnant with their eggs,” says Professor William Ledger from the UK’s Sheffield University. “However, the reality is the most successful results come from women who freeze their eggs in their early 30s, but the majority of women I see in my clinic requesting it are older than that.”
And there’s the ironic issue of the problem. The younger you are when you freeze your eggs, the better your chance of success – in the US, only 26 per cent of freezing centres will even accept women over 40 for the process, while Midland Fertility prefer to treat women under 38. At this point, egg quality is still good and you still produce a reasonable number of eggs per stimulation cycle. This is important as while success rates in conception are increasing, it’s still true that only 80-90 per cent of eggs survive the thawing process, and only about a third of those will fertilise so the more eggs you have stored (most experts say a good number is 15), the better your chance of a successful pregnancy. Generally between the ages of 31-35 is seen as the best time to freeze – balancing maximal fertility and pointless paranoia. However, at 31 or 32 you may still be hoping to conceive naturally and not want to spend the equivalent of around Dhs20,000 (plus Dhs970 a year to store the eggs) on a process you may never need, or undergo a process that leaves you moody, bloated and occasionally at risk of a (potentially fatal) problem called ovarian hyperstimulation where your body overreacts to the drugs.
So, what if you’re already older than 35? Dr Lockwood says, “In this situation you have to look at the comparator. A 44 year old woman who has her eggs frozen at 37 will still have a greater chance of conception using that egg than trying naturally or using her 44 year old egg as part of IVF. In fact, at 44 and using her own eggs, the chance of success in any IVF cycle is just three per cent. For many women, therefore, the only chance of giving birth to a child that’s genetically theirs would be with a frozen egg. Otherwise, it’s using a donor.”
Which brings up the difficult situation in the UAE. Here, you cannot legally use donor eggs (or donor sperm) as part of an IVF treatment, ruling out that option. And neither can women freeze eggs for lifestyle reasons, such as age. It can be offered to single women only prior to chemotherapy “otherwise, egg freezing can currently only be utitlised by married women as part of IVF treatment,” explains Dr Pankaj Shrivastav, director of Sharjah-based clinic Conceive. “If a woman produces 20 eggs during an IVF cycle for example we can freeze 10 of them which is very important for women undergoing IVF.” Recent law changes mean that it is now not possible to freeze embryos (aka fertilised eggs) here so freezing eggs is the best way to allow women with fertility issues to maximise their chances of conceiving a first – or second – child without having to go through the difficult process of egg harvesting again. It doesn’t, however, solve the problem for women not ready or able to have a child, and wanting some fertility reassurance. Of course, if you want a baby badly enough there’s always the option of moving back home where treatment is more easily available, but giving up your UAE lifestyle and moving on is not always an easy decision to make in itself. “My feeling is, when used for medical reasons – ie as part of IVF or pre-cancer treatment, egg freezing is acceptable. If, however, you want to use it so you can get your next promotion, it’s not. If you’re married and desirous of having a child I’d recommend just getting on with it, why leave things to chance?” says Dr Shrivastav. Whatever you believe, the debate will rage – but the good news for women is that while it does, technology in egg freezing is improving and improving, and should the law change in the UAE, we’ll be ready, able and waiting to make the most of it.
Ovary Freezing: The next step
At a recent meeting of the American Society for Reproductive Medicine, US IVF specialist Dr Sherman Silber discussed his belief that ovarian tissue freezing will at some point take over from egg freezing as the single woman’s option of choice. In this process, instead of stimulating the ovary to produce eggs, a sliver of egg containing ovarian tissue (equivalent to about a third of one ovary) is removed and frozen. Done in someone’s 20s (when Dr Silber suggests its optimum) this would give women a bank of around 60,000 eggs to use in the future. However, it’s currently in the early stages, so watch this space.