Harvesting your eggs
Leanne Scott (name changed) was almost 40 by the time she realized that the family she’d always wanted might not materialize. The Vancouver woman had a demanding career and she worked long hours. Plus, although she’d had long-term relationships, she had never met ‘the right guy’the one I wanted to have children with,‘ she says.
When she learned from a friend that it might be possible to stop the clock on her declining fertility by harvesting her eggs, and freezing them’a process called oocyte cryopreservation’until they could be fertilized at a later date, Scott gave it serious thought. She spent five months tracking down a doctor who would agree to perform the procedure. ‘Because of my age [by then she was 43], only two fertility doctors out of 10 that I contacted in different parts of the U.S. and Canada would accept me as a patient,’ she says.
In the end, she went with a clinic in Montreal, but had the required tests done beforehand by a doctor in her hometown. The Vancouver doctor tested her levels of follicle-stimulating hormone (high levels can indicate a dearth of eggs, also called ova) and gave her an ultrasound scan to determine the number of follicles in her ovaries (as a general rule: the more follicles, the more eggs). Having established that her fertility was not obviously compromised, Scott underwent two cycles of egg retrieval, each three months apart, to harvest 20-plus eggs at a cost of about $12,000. The eggs are now suspended in a vat of liquid nitrogen waiting for the day she might try to get pregnant.
Who’s a candidate?
When it first came into use about a decade ago, egg freezing was offered mainly to women who faced fertility-damaging cancer treatments. But about five years ago, clinics began offering the procedure to healthy women who wanted to preserve their fertility. (According to Health Canada, the Assisted Human Reproduction Act and Regulations do not prohibit the freezing of ova for reproductive purposes. However, the donor must give her prior written consent before her ova can be used.) Says Dr. Paul Claman, medical director of the Ottawa Fertility Centre and a professor of obstetrics and gynecology at the University of Ottawa: ‘It’s now quite well-established, and hundreds of babies have been born from frozen eggs.’
According to a March 2012 survey published in the Journal of Obstetrics and Gynaecology Canada, 45 percent of Canadian assisted reproductive technology clinics report offering elective egg freezing for healthy women. The thinking is this: If you freeze your eggs by your early 30s and later decide to use those eggs, you have a 40 to 50 percent chance of getting pregnant. While giving birth later in life ‘is not ideal,’ because you are at higher risk of complications such as miscarriage, hypertension and stillborn or Caesarean births, says Claman, ‘sometimes there’s not a lot of choice.’
The fertility picture changes, however, if you freeze your eggs when you’re over age 35. Your likelihood of getting pregnant is lower, according to Claman. That’s mainly because as you age, you produce fewer eggs and the potential for those eggs to be normal is low. For example, for women over 35 with a high ovarian reserve of eggs, the chances are 20 to 30 percent; for those with low ovarian reserves, it’s less than five percent. Many clinics refuse to harvest eggs from women over 37, and insist on implanting the eggs before the patient turns 50 because of the health concerns, the reduced chance of getting pregnant and concerns they are too old to rear a child. Says Claman: Egg freezing for women age 40-plus is ‘not particularly dangerous.’ But since the chances of a successful future pregnancy are so low for women in this age group, ‘I’d feel like I was stealing their money.’
What it costs
The price of egg freezing is substantial: from $3,500 to $5,850 for the retrieval of the eggs, plus the cost of fertility drugs (around $3,500), egg storage ($1,000 for five years) and in vitro fertilization when it comes time to implant the eggs (about $3,000 to $4,000 per cycle). Even if you are a cancer patient, provincial health insurance plans won’t pay, but under such circumstances some clinics will offer discounts, and extended medical plans may offer partial coverage.
And once you plunk down your cash, there are no guarantees. Freezing eggs is inherently more difficult than freezing sperm, which doctors have been doing for decades, points out Jocelyn Smith, a registered nurse at LifeQuest Centre for Reproductive Medicine in Toronto, which has been offering elective egg freezing since 2010. Nonetheless, Smith says, LifeQuest has had good luck with freezing eggs in short-term emergency situations where women had eggs retrieved for in vitro fertilization (IVF) and weren’t able to use them immediately. In six out of 10 of those cases, babies were born from the thawed and then fertilized eggs.
Smith’s advice: If you are in your early 30s and you’ve found the right guy, but you aren’t quite ready for kids, consider freezing some embryos (fertilized eggs). ‘There is a higher success rate with fertilized eggs than unfertilized eggs,’ she says. She compares the investment in egg freezing to a $10,000 insurance policy that can’t guarantee a payoff.
What are the options?
LifeQuest’s doctors favour a slow-freezing method of preserving eggs, but Dr. Seang Lin Tan, a professor in the department of obstetrics and gynecology at McGill University, has pioneered a method of flash-freezing human eggs (called vitrification) that garners good results. With the slow-freezing method, Tan contends’and he is backed up by Claman and research’about 60 to 70 percent of a woman’s eggs survive, compared to about 85 to 90 percent with vitrification. (The live birth rate per cycle of IVF for slow-freezing is 35 to 40 percent, and for vitrified eggs it’s also about 40 percent.) Since 2005, more than 30 healthy babies conceived at McGill Reproductive Centre, where Tan was founding director, have been born from vitrified frozen eggs.
Bespectacled and energetic, Tan has a 29-year history in the field of reproductive medicine. In 1992, he opened the London Women’s Clinic in the U.K. with Nobel-Prize-winning doctor Robert Edwards, whose work led to the birth of the world’s first test-tube baby. Tan became founding director of the McGill Reproductive Centre in 1996. In 2010, he opened the Montreal Reproductive Centre, to offer egg freezing and other fertility treatments.
While Tan recognizes that elective egg freezing can be a sticky topic for some people, he contends that women should not be penalized for waiting to have their children. A woman is most fertile in her 20s, ‘right at the critical time for completing an education and becoming established in her career,’ he says. ‘A typical man has much more time to become a father.’
The fact is, contends Tan, women generally live to at least 80, so even if they have their children in their 40s, they’re likely to see them through into adulthood. What’s more, he says, now that we have good ways of freezing eggs, there is evidence that they can be as effective as, if not more effective than, older ‘fresh’ eggs. Tan points to a client who froze her eggs at age 36 when she was single. At 43, she and her husband wanted a baby. When her frozen eggs were compared to her fresh eggs, they were of the same quality, he says. But while all of the embryos created from the fresh eggs were chromosomally abnormal, only six of the 10 embryos created from the frozen eggs were abnormal.
In fact, in a 2008 study based in Canada, Mexico and Colombia, Tan and other study authors found only about 2.5 percent of 200 children conceived with vitrified eggs had some kind of fetal abnormality, about the same as rates among children born naturally or through IVF. ‘So far, there has been no suggestion of a higher percentage of problems for babies born of the frozen eggs compared to fresh eggs,’ says Tan.
That said, the process is not an easy one. First, Scott had to inject herself with fertility drugs for more than 10 days in a row so that her ovaries would produce multiple eggs. She then underwent blood tests and ultrasounds before her eggs were retrieved using a long ultrasound-guided needle that went through her vagina and into her ovaries. ‘I was under general anesthetic so I didn’t feel a thing,’ she says. The next day, she had a little tenderness in her abdomen.
For Scott, the process was worth the time, money and discomfort. ‘It’s an opportunity to extend my chance of having a family for a few more years,’ she says. Scott may not, in the end, choose to use the eggs. But even if it never happens, she says: ‘I don’t regret it for one moment. It has given me hope.’
This article was originally titled "Frozen assets" in the September 2013 issue of Best Health. Subscribe today to get the full Best Health experience’and never miss an issue!