Exactly what's involved in putting your fertility on ice?

28th Oct, 2014

By Rowena Walsh, Irish Independent

When it comes to job perks, freezing your eggs may not be quite the treat you were planning to enjoy come bonus time. But it's the latest on offer for female employees at tech giants Apple and Facebook, who are already receive lavish with healthy and wellness benefits to encourage loyalty.

The idea is that women who want to put their careers first no longer have to sacrifice having children. Fertility treatment is seen to 'level the playing field' for female employees, which is something that Facebook's Sheryl Sandberg has long campaigned for.

But whatever about seeming to empower women, there is something fundamentally creepy about your employer becoming involved in your fertility.

Egg freezing allows a woman to have her eggs extracted and stored. They can then be planted into her uterus at a later time, meaning that she can delay getting pregnant. It is becoming increasingly popular among Irish women.

"Seeing so many people going through IVF and ultimately not being able to have children made me think about freezing my eggs. I think of it as an insurance policy," says Aoife (not her real name).

"I am in a relationship now, but it's early days and I don't want children right now. It's not the right time for me," says the 29-year-old office worker.

"I haven't discussed it with my partner, it was a decision I made before I met him, but I have spoken to my friends. Some of them are in the same boat and they are also thinking doing it.

"Although I don't know anyone who has had the procedure, there doesn't seem to be any downside. If it saves you going through a lot of stress and an ordeal later in life, why wouldn't you do it. It is expensive, but it's good value compared with going through a lot of fertility treatments when I'm older. I know it isn't a guarantee, but it does take the pressure off.

Dr Ahmed Omar of Beacon CARE Fertility, a clinic offering social egg-freezing in Ireland, is seeing many more women like Aoife, who are willing to pay a fertility insurance policy. It is one way to deal with the insidious ticking of our biological clocks, as well as the doom-mongering about the fertility cliff women hit when they reach 35. Beacon CARE Fertility charges €3,000 for the process, which includes freezing for the first year, and a €500 annual fee for storage after that. There is an extra charge for additional cycles.

Social egg-freezing is a relatively new concept in Ireland. Beacon CARE Fertility started offering the procedure a couple of years ago and they are currently doing two or three treatments per month. Of the women who come in for a consultation, between 70 and 80pc go through with the procedure. "There are many reasons why women may want to freeze their eggs," says Dr Omar, "and sometimes it simply just isn't appropriate or possible to have babies at the most fertile age."

When they're born, girls have two million eggs, a figure which drops to about 400,000 by the time we reach reproductive age and when a women reaches her 35th birthday, about 95pc of her ovarian reserves gone. Matters are further complicated by the fact that the quality of her eggs has diminished too, so becoming pregnant naturally can be a struggle.

In Dr Omar's experience, there are three main groups of women who are interested.

The majority either want to establish their careers before having a baby or haven't met the right man yet and are worried that it might be too late by the time they do.

Others are concerned about their family history of premature menopause or ovarian cancer and may be thinking of having their ovaries removed. A smaller group work in a hazardous situations, for example in a chemical factory or around pesticides.

Martina Kelly, the clinical director of the Clane Fertility Clinic, says that when they first offered the procedure, it will mainly taken up by single women focused on their career, but their clientele is now more varied, including those who are still in education - sometimes families will make provision for that, this is a very typical scenario in the US - to those who always wanted a family and wish to optimise their potential whatever their background.

Meanwhile Dr Omar says that it takes courage to go through the treatment and "there is no guarantee that frozen eggs will result in a successful future pregnancy".

The collected eggs are put through a process of flash-freezing or 'vitrification'. This has had a major impact in the success of egg freezing. According to Dr Omar, previously the process involved slow-freezing of eggs, and the results weren't great - between 2 and 10pc based on a study because of this mechanism. It caused crystals to form in the eggs, which damaged them.

"In a few years, the number of women having the treatment will be much higher and the chances of achieving a baby thanks to frozen eggs will be much higher. One day, there will be no difference between a woman who freezes her eggs at 35 and one who uses her eggs fresh at the same age.

"Hundreds of babies have now been born worldwide using previously frozen, thawed mature eggs. Using advanced techniques, the average success rates using frozen eggs continue to increase at Beacon CARE Fertility and its UK sister clinics, and is now at 39.5pc per attempt."

However, to date, only a single patient at the Irish clinic has used her frozen eggs. The 37-year-old had left 13 eggs in storage for a year, and so far has not given birth.

Egg freezing is certainly not a panacea for those worried about their fertility, a view strongly felt by Dr John Waterstone, medical director of Waterstone Clinic

"No Irish fertility unit has yet frozen an egg, thawed it, fertilised it and produced a successful pregnancy," he says, adding that, theoretically egg freezing makes a lot of sense, but there's a gulf between theory and practice, particularly with regard to the success rates of the technology.

"There are no guarantees in reproductive medicine, and the data from the US is not encouraging with regard to the success of a woman having frozen her eggs, even repeatedly, would have a baby as a result. There is maybe a 19pc chance."

Dr Waterstone believes social egg-freezing encourages women to put off having babies, and "at the present stage of technology, I couldn't advocate getting it done in Ireland or England. They haven't achieved proven high success rates because it hasn't been used a lot in egg donation. Go to the US or Spain, or a place where they freeze eggs a lot as part of the egg donation process." This enables them to perfect their techniques freezing and thawing them in a short time frame to find out if the process really works.

As more women like Aoife opt for a fertility insurance policy, Dr Omar points out that some who do freeze their eggs will never need them.

"It's a safety plan. They might be the right person in the next year or two and go on to get pregnant naturally."

So, what's involved?

It begins with a thorough medical consultation and a woman's ovarian reserves are checked through an AMH blood test. Dr Omar is insistent that it is imperative that women must be very informed in order to manage expectations before they go through the procedure.

After a woman turns 40, her ovarian reserves will be quite low, and the risk of chromosomal abnormalities, such as Down syndrome, and miscarriage are higher. The process involves a woman injecting themselves with ovulation stimulants on a daily basis for two weeks prior to the egg collection and getting scanned every three to four days.

Everyone's ovarian reserves are different and the quantity and quality of eggs will differ depending on the person.

The process of egg retrieval involves conscious sedation and it's done by trans-vaginal ultrasound. A small needle is passed into the follicles and the solution is sucked into the test tube. This is then passed on to the embryologist who look at them under a microscope to see if an egg has been retrieved. If so, they will assess whether they are mature enough - normally 80-90pc will be, however. The eggs are then flash-frozen in a process of vitrification. When a woman decides to use her eggs, sperm is injected into them and they are fertilised to become embryos. The strongest one or two are then implanted into the woman, and it is hoped that pregnancy will result.

 
 

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