Motherhood on ice

A growing number of women are choosing to freeze their eggs as game-changing technology brings cryopreservation into the mainstream.

It’s a Thursday night in an elegant part of Melbourne’s Flinders Lane, and almost 200 pairs of heels click-clack down four flights of stairs to an old warehouse basement-turned-art venue. The women are offered a free glass of wine and a dainty hors d’oeuvre. But they’re not here for the art. The women, in their late 20s, 30s and possibly early 40s, have come to this “Eggs and the City” seminar to learn how to freeze their eggs.

There’s not a spare seat in the house as Melbourne IVF specialist Dr Manuela Toledo, who has impressively neat teeth and wears a charcoal-blue pant suit, takes to the stage. On a poster behind her a motherly hand cradles a tiny foot under the message: “Turn hope into happiness.” But Toledo’s talk isn’t designed to deliver hope. It’s about the grim reality of ageing eggs.

Toledo’s Power Point presentation shows images of a young woman’s ovary next to that of a 42-year-old’s. The former is a picture of fecundity, with thousands of little primordial follicles containing eggs. The latter is as desolate as a salt pan. Women suffer a pronounced decline in fertility after 35 and more markedly again after 40, when the quality and number of their eggs becomes further compromised and miscarriage rates soar. Big Brother Australia and Mornings host Sonia Kruger, who became a mother for the first time in January at the age of 49, has never concealed the role science played in her joy: “I have a very good friend who gave me an egg,” she told Mornings after announcing the long-awaited pregnancy.

 

But there’s some good news tonight, too, and here to deliver it is a fertility preservation specialist, Associate Professor Kate Stern, from Melbourne IVF and the Royal Women’s Hospital. Like Toledo, Stern is funny and sympathetic. Egg freezing offers no guarantees of a pregnancy, but is a “very reasonable option to consider”. Freeze your eggs now, she offers, and you can come back in a few years with either a partner or donor sperm. “It’s a little bit of extra opportunity and a little bit of extra control,” she adds.

The seminar marks a significant shift in how Melbourne IVF, part of Australia’s largest IVF provider,

Virtus Health, approaches the procedure. This is its first attempt to sell the technology in roadshow format – that is, outside the walls of the clinic – and follows two similar croissants-and-coffee events in Sydney hosted by sister clinic IVF Australia.

 

Human oocyte cryopreservation (or egg freezing) is moving slowly into the mainstream – and not just because Kim Kardashian was very publicly considering freezing hers before she became pregnant with daughter North by Kanye West in 2012. What’s driving the growth in interest is a technological game-changer: a new flash-freezing technique called vitrification, perfected in the past five years by Italian fertility specialists. It has meant that almost 90 per cent of eggs now survive the thawing process: previously, the survival rate for thawed eggs was just 20 per cent. As a result, frozen eggs now enjoy almost the same success rate as fresh eggs in terms of producing a viable pregnancy resulting in a live birth. In late 2012, the Alabama-based American Society for Reproductive Medicine announced that the technology was no longer experimental.

Last October, Apple and Facebook controversially declared they would give $20,000 to every female employee considering freezing her eggs. In a statement, the former said, “We want to empower women at Apple to do the best work of their lives as they care for loved ones and raise their families.” For some, the move signalled that motherhood in prime childbearing years conflicted with career success: why didn’t these companies focus on making workplaces more family-friendly? But for others, there’s a broader discussion taking place.

Professor Gab Kovacs, reproductive gynaecologist and specialist in reproductive endocrinology at Monash IVF, believes a woman’s chances of giving birth to a baby after using frozen eggs harvested from ovaries that are in their late 30s or early 40s are so slim that it simply isn’t worth the cost and heartache.

 

“I recently saw four women in one week,” he says. “They were 38, 39, 40 and 41. I told them the horse has bolted.” His advice to older women is to try to make a baby pronto using their own eggs (or a fresh donor egg) and either donor sperm or the contribution of a “Mr Not Too Bad”. IVF clinics pushing the technology worry him. “It’s just not effective enough to be advertised,” he says.

Sydney gynaecologist and IVF specialist Devora Lieberman of Genea, a provider of fertility and IVF treatments that operates clinics across metropolitan Sydney and regionally in NSW and the ACT, agrees. “My concern is about the hype and the overselling of the technology as a solution. If you want no regrets down the track and you’ve got the disposable income, it’s a reasonable thing to do. But women should not think this will assure them of a baby. You don’t want to be selling snake oil and you don’t want to be frightening women into thinking they have to do this.”

Sarah Young is a speech pathologist who works with children in a private practice. She has shoulder-length blonde hair and lives in Melbourne’s Northcote. She froze her eggs last year at 39 after a long-term relationship ended. Over tea and biscuits, she talks proudly about her “seven little eggs” tucked away in a Melbourne IVF storage facility. “I was quite fascinated by the whole process,” says Young, who will soon pay another $10,000 to have a second batch of eggs harvested.

Cold comfort: Eggs are being cryogenically frozen for future reproductive purposes.Young refuses to see herself as a victim. She travelled widely, spent seven years in London, established a career, came home and found herself in a long-term relationship during “the really crucial years”. Ultimately, though, she and her partner weren’t suited. “I’m open to meeting the man of my dreams and I’d rather be single until that heart-flipping legend comes along than settle for something mediocre. The egg-freezing has allowed me to relax into that. And if I don’t ever use them, I’ll donate them.”

Young is a typical freezer: educated, successful, driven. You get the feeling that there’d be little in life she couldn’t accomplish – except, perhaps, guide the aim of Cupid’s fickle arrow.

There are no national figures but one clinic, Monash IVF, reports almost a tripling in frozen-egg cycles for Young’s type of “social infertility” – from 11 women in 2013 to 29 in 2014. Social infertility is the term used to differentiate partnerless women from medically infertile patients. Egg-freezing for cancer patients – typically, their eggs are removed before a treatment such as chemotherapy destroys them – accounts for about 80 per cent of egg-freezing cycles and is the reason the technology was developed in the first place.

Cold comfort: Eggs are being cryogenically frozen for future reproductive purposes. Photo: Getty Images

 

Sarah Young is a speech pathologist who works with children in a private practice.The Jean Hailes Research Unit at Monash University recently surveyed 100 clients of Melbourne IVF and found that the average age of the women at the time of freezing was 36. Ninety per cent were tertiary educated and in professional occupations and nearly all had private health insurance. Almost all of them were choosing oocyte cryotherapy because they were not in a relationship, a finding that challenges the narrative that high-powered, tertiary-educated egg-freezers are delaying motherhood – or wasting their fertile years – in pursuit of career success. “It’s actually not having a partner that drives this more than anything,” confirms Monash senior research fellow Karin Hammarberg.

Says her colleague, Professor Jane Fisher, “In so many adverse reproductive outcomes, a woman is blamed. She is impulsive and poorly controlled if she has an unintended pregnancy. If she delays childbearing, she’s somehow selfish or overambitious. Our work shows this is not true … The big problem for contemporary women is finding a man who is willing to commit to a partnership, then commit to fatherhood.”

Sarah Young is a speech pathologist who works with children in a private practice. Photo: Luis Ascui

 

The bigger societal problem here, suggest Hammarberg, Fisher and colleague Maggie Kirkman, is a growing schism between the biological imperatives and life plans of tertiary-educated women and those of their tertiary-educated male peers. Addressing this problem, says Fisher, requires men to understand the limits of their partners’ fertility and commit to fatherhood even if they, in their mid-30s, may not feel quite ready themselves.

There are other reasons, of course, all previously aired in endless articles about the “man drought”. Members of the current childbearing generation like to keep their options open, have more debt and are less likely to stay in bad marriages than their parents, leading to significant breakups during their crucial 30s.

Studies of Australian fertility trends predict that of the 90 per cent of women who want children, 25 per cent will not have them. “This is not about all women; it’s about particular women and it’s especially about educated women,” says Martha Hickey, a gynaecology and obstetrics professor at the University of Melbourne and the Royal Women’s Hospital. Her team is working on a decision-making tool to help women navigate egg-freezing. “I question the term ‘social egg-freezing’. This isn’t a convenience thing, like going to get your legs waxed or nails done. This is a major dilemma women are being put in, partly by men.”

peace of mind. that’s what $10,000 – or most likely $20,000 – buys a woman after she has made the decision to freeze her eggs. The baby panic ebbs away; the relentless ticking of the biological clock quietens.

Jen*, a Sydney woman, froze 11 eggs when she was 35 after a standard fertility test revealed a low egg reserve. The test measures in a blood sample the level of anti- mullerian hormone (or AMH), which is secreted by cells in developing egg sacs. It’s an efficient indicator of how many eggs a woman has, but not their quality and, as a result, some fertility specialists are wary of its usefulness. For Jen, the test result was a shock. “I’m just trying to afford a double bed from Ikea,” she remembers thinking, “and you’re telling me I have to find a husband, or someone to knock me up, in the next few years?”

Jen would like to see counselling on egg-freezing become readily available to single women, a Medicare rebate on the cost of harvesting their eggs, and more honesty from the IVF industry about the performance of older oocytes. But she has no regrets. “I sleep a lot easier at night knowing I’ve done it,” she says. “Now when I go to a kid’s birthday party or christening,

I don’t leave in tears. Fertility splits the sisterhood into the haves and the have-nots. It has helped me to emotionally move on with my life.”

The other upside of freezing, many women report, is better partnering decisions, the product of a more relaxed attitude to dating: they can meet men without radiating the desperation caused by a clutch of rapidly deteriorating eggs.

Another Sydney woman, education consultant Sheridan Lamb, also had low ovarian function and, last November at 34, froze more than 20 eggs after her marriage broke up a year earlier. “Everything is different now,” she says. “Before the egg-harvesting, I was sad; I was coming to relationships broken. It’s given me confidence and calmness.”

Queenslander Karen* froze 13 eggs at 36 and is yet to use them eight years later. She believes 18-year-olds should be encouraged to consider egg-freezing, a development she believes will create career equality between the sexes by giving women the chance to become established in their careers before they become mothers. Now 44, she is still waiting for her “knight in shining armour”. “If I hadn’t frozen my eggs, I would have felt more pressure to make a relationship – any relationship – work,” she says. Melbourne IVF director John McBain puts it another way: “Egg freezing is much cleaner than tying up your fertility with a man you may no longer be with in six or seven years’ time.”

For 36-year-old Cynthia from Melbourne, being a mother is not “the ultimate aspiration”; satisfying the needs of her future partner is, however. If he wants kids, she wants to provide them. Cynthia was prepared to spend $45,000 to secure a good haul of eggs, but didn’t need to in the end. At the good freezing age of 34, Cynthia had 25 eggs harvested, from which she was able to freeze 18 (not every egg harvested is mature enough or viable for conception).

Cynthia’s boyfriend, who’s six years younger than her, is “probably not ready to have a child”, she says. When they met, Cynthia told him about her egg-freezing plans and “he thought it was the smartest idea I’d had”.

Lisa Lam, a Sydney-based insurance project manager, made the decision to freeze seven eggs just before she turned 40 even though doctors at the seminar she attended warned that they would be unlikely to offer the procedure to a woman over the age of 38. She made the decision on the basis of an encouraging fertility test, but concedes that she was lucky to slip through a closing window of opportunity. “If a single woman in her early 30s would like to have children one day,” she says, “she should take the time to do some research and speak to a specialist about her options.”

At a breakfast seminar hosted by ivf Australia at Establishment, an upmarket bar in Sydney, a woman asks a question about freezing eggs at 40. “We’re not keen on it,” replies specialist William Ledger. “You would have to freeze 130 eggs to have a 50 per cent chance of having a baby. The best thing you can do at 40 is to try to have a baby.” There are gasps across the room. The average 40-year-old will secure fewer than 10 eggs each harvest: 130 eggs could cost at least $130,000. And still there’s only a 50 per cent chance of success.

Louise Johnson, chief executive of the Victorian Assisted Reproductive Treatment Authority (VARTA), which is required by law to regulate IVF clinics, recommends that prospective patient ask about an individual clinic’s track record in using frozen eggs. But as a rule of thumb, she says, a 30-year-old woman with a haul of 24 eggs has a less than 40 per cent chance of having a baby using the new technique. The chances of a live birth resulting from eggs frozen in your late 30s and early 40s are, she cautions, “very, very slim”.

For context, let’s consider natural conception rates. According to the American Society for Reproductive Medicine, a 30-year-old woman’s chance of conceiving through regular intercourse is 20 per cent each menstrual cycle. By the time she’s 40, that falls to less than five per cent each cycle.

To use a frozen egg, a woman must find some sperm – contributed either by her partner or a donor – and go through IVF to create and implant embryos. A 2012 study of IVF in Australia and New Zealand conducted by the University of NSW found that for women aged between 40 and 44, an embryo transfer has an 8.8 per cent chance of proceeding to a live birth. Prospective freezers can also consult an online egg-freezing calculator developed by respected American fertility preservation expert Kutluk Oktay (find it on i-fertility.net). A 40-year-old with 10 thawed eggs has, for example, a 15.3 per cent chance of developing a clinical pregnancy.

There’s no escaping how lucrative this technology could be for the $550 million Australian IVF industry, particularly if companies here follow the examples of Apple and Facebook. Last year, American fertility expert Geoffrey Sher told Bloomberg that “the potential market for egg-freezing is exponentially larger than that of in-vitro fertilisation”, particularly because it is a process that can pre-empt a diagnosis of infertility.

In the United States, companies are targeting potential grandparents, urging them to consider funding their daughter’s egg-freezing. For Melbourne IVF’s John McBain, this is not an unreasonable development. “My view is that parents have to take a hand in this. If you’ve got a 30-year-old daughter with no partner and a career, you might consider giving her a cycle of egg-harvesting for her 30th birthday.” (Indeed, Professor Kovacs has recently treated a 30-year-old social worker whose parents did just that.)

Kate Stern sees the “Eggs and the City” nights as an important exercise in public education because the vast majority of women are still ignorant of the ephemeral nature of their fertility. This leads to a mismatch between the average age of women who choose to freeze their eggs – 36 – and the age they should be using this technology to ensure a positive outcome – more like 26. Stern raises the prospect of turning egg-freezing around: instead of making the decision to freeze their eggs “in the sad situation of feeling your life hasn’t gone the way you wanted”, women need to make a positive decision to take charge of their reproductive future in their 20s.

Writing about Facebook and Apple’s proposal to finance the oocyte cryopreservation of their female workforce, columnist Miranda Devine commented in Sydney’s Daily Telegraph last October that the biological clock has an important function. “It imposes discipline on the sexual lives of young women and men,” she wrote. Women seek out worthwhile mates to have children, which adds “a seriousness and a goal” to the dating scene, “taming” men and women. “If the pressure is off and women don’t care, all that’s left is an alpha society of mindless hedonists, with a second-class citizenry who breed naturally.”

Sarah Young isn’t concerned that her 39-year-old stored eggs are no guarantee of a baby. “I’ve done something really exciting that has increased the time frame and likelihood of being able to create a family of my own.” And Mr Right? He’ll come along. “I’ve fallen in love in the past and have no question I will fall in love again.”

* Not their real names.

http://www.smh.com.au/good-weekend/motherhood-on-ice-20150605-ghfwga
Melissa Fyfe and Julie-Anne Davies

 

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