Tick Tock… Stop the Biological Clock

7th June 2019

In a bid to protect their fertility, more and more women are choosing to freeze their eggs. Jennifer Lipman looks at the health and social considerations that are driving this trend, and what it could mean for the wider questions facing women around motherhood and careers…

At 34, Emily Hartridge, personal trainer and founder of the worldwide hit YouTube show 10 Reasons Why, had been single for eight years when the subject of freezing her eggs first came up. She didn’t want the fact that she hadn’t (yet) met the right person to stop her from becoming a mother, and, as an initial step, underwent fertility testing. “I was fit, healthy and thought I would be totally fine – turns out it doesn’t quite work like that,” she explains. “I had very low fertility for someone my age. It was extremely hard to hear.”

After this devastating news sank in, Emily’s doctor suggested the idea of egg freezing (or oocyte cryopreservation, to give it its technical term) and, last autumn, she began that process, becoming one of a rising number of women taking their fertility into their own hands. “I wanted to give myself the best possible chance of still having my own children, whenever that might be,” she says.

According to the Human Fertilisation and Embryology (HFEA) Authority, the number of egg freezing cycles has almost doubled since 2013, with 2016 seeing 1,310 cycles and 10,253 eggs stored.

While overall numbers remain low – still just 1.5% of total fertility cycles – a procedure that might once have been seen as something from science fiction is now becoming increasingly commonplace.
Essentially, it’s a way of stopping that infamous biological clock. “Your eggs remain the age you are when you freeze them,” explains Marta Wolska of the London Women’s Clinic-affiliated London Egg Bank. “This gives you the freedom to make other life choices and still have the option to try for motherhood later. Another benefit is that you can have some eggs frozen as a safeguard and still have the chance to try to conceive naturally.”

As Professor Nick Macklon, the London Women’s Clinic medical director, sets out, there are two predominant motivations. Until recently the main one was medical – for a woman facing radiotherapy, chemotherapy or another serious medical condition that could damage her ovaries. “If she freezes eggs before starting this treatment, and finds that after recovery her ovaries are no longer fertile, she can use the frozen steroid eggs for IVF,” he says. But more and more women are now doing this to retain options for future fertility.” “Should life events have conspired to make [starting a family] difficult, being able to access their own [frozen] eggs offers alternatives to treatments such as egg donation.”

Predictably, some question the latter motive. But, as Professor Geeta Nargund, Medical Director of CREATE Fertility, points out, there are myriad reasons a woman might not be able to have children while at peak fertility, from financial to personal, including “wishing to pursue education or a career further, the need to care for ill family members, or just as a means of easing the pressure from a relationship”.

She sees it as a lifeline for women. “One of the most difficult parts of my job is dealing with women who had no idea of their fertility status and now have very little control over whether they are able to conceive a much-wanted child,” she says. “After 35, female fertility declines sharply. Egg freezing offers women a chance to take back that control.” 

The process involves daily injections of follicle-stimulating hormone, then regular testing to detect when follicles have ripened. “You then receive a trigger injection under the skin to achieve the maturation of eggs,” explains Dr Nargund. “Egg collection is planned for 36 hours after.”

Like almost anything to do with fertility and childrearing, it’s not without controversy, with particular concerns raised about whether clinics inflate the chances of successful conception using frozen eggs. As the HFEA highlights, the birth rate for patients using their frozen eggs has risen slightly from 12% in 2014 to 18% in 2016, but remains considerably lower than the 26% IVF success rate.

One of the key challenges is the age you are when your eggs are frozen. According to Aileen Feeney, Chief Executive of Fertility Network UK, female fertility has already begun to fall by 28; by 35 it plummets, and by 42 “your chance of becoming a biological mother is vanishingly small”. This is equally true for frozen eggs; theoretically, eggs can be frozen whenever a woman can become pregnant naturally, but the younger you are, the better chance of them being of sufficiently high quality. “Doing so in your 20s or early 30s offers a greater chance of future success,” advises Feeney.

There’s a snag, however. UK law requires women to use their eggs within ten years of freezing (unless there are medical reasons), creating something of a Catch-22. “Doing this in your 20s – while effective in terms of chance of conceiving – means there is a risk that you will need to use them before you wish to,” says Professor Macklon.

The ten-year-limit was laid down by the 1990 Human Fertilisation and Embryology Act. The slow-freezing methods in use at that time were not delivering good long-term survival rates, but science has moved on, and campaigners are now pushing for change, arguing that the deadline restricts women’s choices and is no longer appropriate. One woman with eggs in frozen storage has recently launched a legal challenge, and is seeking a judicial review ahead of their imminent destruction. The newer freezing technique, called vitrification, adopted widely around ten years ago, allows eggs to be stored almost indefinitely without deterioration. The women who were the pioneers of this process are those who are now facing the loss of their stored eggs – and thus their possible future families.
“This limit was decided many years ago when the long-term storage effects of eggs were not known,” explains Dr Nargund. “It discourages women from freezing their eggs at a younger age when they are at their most healthy.”

After Emily decided to go ahead, she did so quickly, starting the process on her next period. Diving in, she says, was helpful “because there wasn’t too much time to think about it all”. She was fortunate, of course, that her mother was willing and able to stump up for the £15,000 price tag.

At present, egg freezing is only available on the NHS for medical reasons. Although costs vary, even the cheapest procedure will usually cost upwards of £3,500, with additional storage fees. All this, with no guarantee of success.

“The costs are insane, especially if you are doing three rounds,” Emily acknowledges. “There is absolutely no way I could afford to do it without my parents’ help. I know how lucky I am.”
For advocates, the challenge is to make egg freezing more affordable – and the hope is that success rates will only improve. That’s not to say the process is all smooth sailing, either initially or later, when a woman wants to use her frozen eggs. “As with any procedure, there are some risks,” says Wolska, including bloating or fatigue. She adds that, because success is far from a certainty, women need to manage their expectations. “This is by no means a guarantee that you will be able to have a baby.”

Feeney echoes this, noting that future partners might also have fertility issues. And she stresses that women must understand what using frozen eggs will entail. “They will need to go through IVF, which is not easy, and, if they are self-funding, also not cheap.”

Emily tried not to think about this aspect of it. “I like to live in hope,” she says. A friend who underwent the procedure had to stop because of complications. “I was so sad for her because I know how I would have felt if that was me.” Thankfully, her first two cycles have yielded eight eggs, and she is about to embark on her third and final round.

Her experience has been generally positive, but due diligence is wise, on the process itself and on your doctors too. The HFEA’s clinic comparison tool is a good starting point. “Success is highly dependent on the expertise of the laboratory,” says Professor Macklon, advising that women consider clinics with proven success not only in freezing but thawing frozen eggs and creating pregnancies with them.  

Ironically, after those wilderness years Emily is in a new relationship. Freezing her eggs won’t prevent her conceiving naturally, of course – but, whatever happens, she is clear she made the right decision. “How I thought of it was that, I am not going to be getting pregnant in the next ten months so instead of losing those eggs each month why not try save them.”

She has no time for those who see egg freezing as a lifestyle choice for the privileged. “The important word here is ‘choice’. It is the woman’s choice. It has nothing to do with anyone else,” she says. “I think men don’t quite realise how lucky they are. Women have a constant biological clock ticking in their heads.”

Ultimately, her eggs may or may not become a baby – but in freezing them, she has given herself more options later.  “I have taken control and that’s a good feeling.”

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