In an age of competing priorities – career, relationships, lifestyle and mortgages among others – a medical option which offers to preserve your fertility while you get your life sorted can seem like manna from heaven.
Egg freezing is being promoted as the latest and greatest way for women to take control of their lives both personally and professionally. Some speak of it as an insurance policy, suggesting that women can delay motherhood while they focus on education, career and finding the right partner. And for some women, that’s exactly how it will work. However, it’s important that discussions about egg freezing are honest, so we have to acknowledge that for some women, egg freezing will be, at best, an insurance policy against regret.
So how do you figure out which camp you will fall into and ultimately, how do you decide if egg freezing is the right choice for you?
“What any woman who is considering this procedure should ask is: what chance do I have that eggs I freeze now will become babies, and is that chance worth the physical and financial cost?” Genea Fertility Specialist Dr Devora Lieberman says.
Why is this an issue?
First up it’s worth explaining just why egg freezing has become a topic for consideration. It’s all down to the fact that one of the main factors we cannot overcome when it comes to fertility is age.
A woman’s most fertile years are their 20s and early 30s. Data that is relied upon around the world shows that a woman’s chance of getting pregnant naturally each month actually falls from the age of 22.
By the time a woman is 36, their chance of conceiving per month is decreased by half – and that’s if there are no other factors at play. The downward slope continues until by age 45 the average natural fertility rate per month is approximately one per cent.
The problem is that women are born with all of the eggs they will ever have and those eggs fall in both quantity and quality as we age. And that’s not a problem even IVF can easily solve.
“Many women I see as patients in their late 30s and early 40s struggling with infertility feel betrayed by their bodies and science. They were under the misapprehension that IVF would always be there for them when they needed it,” Dr Lieberman says.
Will it work?
Egg freezing is currently our best way of trying to overcome the impact of age on fertility by snap freezing a good quantity of eggs while they are still good quality thereby giving women the opportunity to come back and use them when they are ready.
Sperm and embryos (eggs that have already been fertilised and developed for a few days) have been frozen as part of fertility treatment for decades, so the notion of cryopreserving fertility isn’t new. Eggs have also been frozen but the reality is that it is quite a bit simpler to collect sperm than eggs, and embryos and sperm survive the freeze-thaw process more robustly than eggs. Eggs are the largest cell in the human body, but they are filled with fluid and are very delicate structures that are critical to successful embryo development.
There is no particular scientific advantage from the storage of embryos derived from combining eggs with donor sperm, compared to freezing unfertilized eggs. In fact freezing unfertilized eggs will keep future fertility options wider and will therefore give women a higher chance of achieving a baby in the future.
With egg freezing, a woman gives herself a much better chance of future success if lots of eggs are preserved, so Fertility Specialists augment and control the natural process of ovulation through a series of injections. It usually takes approximately 10 days for follicles to have mature eggs. Ovulation is then triggered and eggs are collected through a needle inserted through the top of the vagina under ultrasound guidance. This procedure takes approximately 10 minutes, and can be done under general anaesthetic if required.
Those eggs are then frozen using a method called vitrification – essentially snap freezing – and stored until the woman decides to use them.
At that point the eggs are warmed and injected with sperm in a procedure called ICSI (intracytoplasmic sperm injection). They then have to fertilise normally and create embryos and then those embryos have to go on to make babies. Human reproduction is surprisingly complicated and inefficient given the attrition rates at each step of this process.
So back to the question of whether or not egg freezing works. The probability of a woman having a live birth using her frozen eggs depends on her age when they were collected and the number of successfully warmed eggs. There are also likely to be differences in success rates among clinics.
While we’ve been freezing and vitrifying eggs for many years in Australia, the number of women returning to use their frozen eggs in an attempt to get pregnant is not yet at a level where we can provide reliable and meaningful data on the Australian experience.
However, data being used internationally indicates an overall chance of success ranging from 5 to 50 per cent depending on the number of eggs vitrified and the age at which they were frozen.
What else to consider?
As well as the updates to technology that have made this fertility option far more successful, thankfully attitudes have also changed. Gone are the days where freezing your eggs was seen as a last resort or a sign of failure, rather these days many Australian women perceive it as a smart choice in their early 30s, a proactive and prudent decision to give themselves breathing space.
“Initially when I froze my eggs there was a bit of a negative social media reaction but in the two years since then it has become far less rare and now when I talk about it, it’s like ‘oh yeah, sure, why wouldn’t you do that?’,” says Juliette Saly who froze her eggs in mid-2014 when she was 34. She became a groundbreaker in the process by covering her own treatment for The Today Show in an effort to break down the stigma surrounding it.
A key issue that discussions about egg numbers and chances of success don’t address is that there is often an emotional health boost gained from taking back control in an area of life that may have seemed to be outside their grasp.
Juliette says; “The morning after my second cycle I was ecstatic, it went really well. In every sense, I am a lot calmer now. I know that I have done everything that I can.”
Dr Lieberman says as with all matters fertility-related, power and the key to making the right decision lies in knowledge and education.
“My position is that where we can we should be educating and informing women about their fertility and its finite nature. They should have access to accurate and unbiased information about both their current fertility and their options for managing their fertility into the future,” she says.
“I understand that for some women, the process of having their eggs frozen is just as much about them doing something to take control of their fertility as it is them attempting to secure the chance to have a child later in life. I support that choice as well, as long as it is educated and made without undue influence from outside sources.
“What I hope for all of my patients down the track is that they have no regrets. That they know that they made the best decisions they could at the time that they made them with the information, technology and financial resources they had at the time.”
Although egg freezing technology has greatly improved over the past decade, it should not be considered an insurance policy. The reality is that freezing your eggs and storing them will not guarantee you a child in the future.
The information in this article does not replace medical advice. Medical and scientific information may or may not be relevant to your own circumstances and should always be discussed with your own doctor before you act on it.
This blog post is sponsored by Genea