Sunday 24 September 2017

Facing fertility: 'social egg freezing'

An innocuous-looking building in Kildare is home to the 'precious cargo' of a growing number of Irish women. As they put off motherhood until their careers are established, or until they meet Mr Right, these women are signing up for 'social egg-freezing' and keeping their chances of having a child on ice. But not everyone is a fan of the process, with critics saying that its success is unproven and that it's offering false hope to a generation. Photography by Kip Carroll

‘Some patients embrace it, but other patients are often very upset to have to be here’ — Martina Kelly, clinical director at the Clane Fertility Clinic. Photo: Kip Carroll
‘Some patients embrace it, but other patients are often very upset to have to be here’ — Martina Kelly, clinical director at the Clane Fertility Clinic. Photo: Kip Carroll
Anne-Marie Scully
Dr. John Waterstone
Joanna Kiernan

Joanna Kiernan

Kate Murphy, 36, from Dublin is one of a number of Irish women who has chosen to avail of the social egg-freezing procedure now being offered by just two of the eight Irish fertility clinics. "I've been working in marketing for years, in a really full-on job, and I was going out with a guy and it didn't work out. Loads of my friends are married with, like, two or three kids and so I suppose I began to worry that I might have missed the boat," she says.

"I'm just hedging my bets, really. I know it's still not guaranteed, but it has something like a 33 per cent success rate. So, at the very least, it takes the pressure off."

Many Irish women are now opting for this 'egg-surance'. After all, in our 20s, women's fertility is at its peak, but, by the age of 30, only about one-eighth of the two million eggs we are born with remain. By the age of 40, a woman has a less than 10 per cent chance of conceiving and, by the age of 45, this decreases again to approximately one per cent. So, is it little wonder that we are so desperate to fool nature?

"At the start, they take your bloods and they tell you whether or not you're an eligible candidate or not," Kate explains. "So there could have been a chance that they'd have turned around and said, 'You're not a suitable candidate and there's no point wasting your time and money,' but they came back and said that I actually had quite a high egg reserve. Hearing that made me much more chilled out about the whole thing."

Kate plans to spend €4,750 on the initial procedure, €360 per year storing her eggs, and a further €2,000 on the eventual thawing and embryo replacement.

Then, depending on her personal circumstances, when she returns to try to conceive, she may also need to pay for sperm donation should there be no Mr Right in tow at the time.

For Kate, the relief of knowing she has this egg-surance is priceless. "It's a weight off my shoulders. At least now I've looked after that and I know I'm doing all that I can," she explains. "I wish I had thought of it when I was younger, but I didn't have that mindset. You always think things will just work out. I'm sure, down the line, in 10 years' time, it's something that women will just do. It's not cheap to do, but I think it's worth it." It might be money well spent in Kate's eyes, but not everyone agrees.

"I told a couple of my friends that I was getting it done, and most of them thought it was a great idea. But one of them, she was a bit anti it and I was surprised by her, to be honest," Kate says. "She thought that if it's meant to be, it's meant to be, and that I shouldn't force nature. I think that is really narrow-minded. Society is changing, people are not rushing into things any more. They're not settling down with someone when they're 25.

"If I want to do everything I can to make sure I can have a baby down the line, then who is anyone to judge?"

According to the Irish Economic and Social Research Institute (ESRI), 29 per cent of Irish mothers in 2011 were at least 35 years of age, and 17 per cent of first births were to women in this age category. Being an older mother has become increasingly fashionable, too, with celebrities such as Nicole Kidman, Halle Berry and Mariah Carey all having their first babies in their 40s.

These days, it seems, the gradual crescendo of one's biological clock ticking is not something to fear, but, rather, something to manage, and the resulting demand for solutions has been met with a supply of various services to address the shortcomings of our fertility, such as social egg-freezing for single women, and IVF to a wider age bracket of potential mothers than ever before.

In the United States, egg-freezing has become so common that thousands of females in their 20s and 30s are presenting for the procedure each year. Often, they are flanked by their parents, to lend moral, emotional and even financial support, and to ensure their possibility of grandchildren.

At the Clane Fertility Clinic, Martina Kelly, the clinical director, is all-too-aware of how private and intensely emotional a subject fertility can be for people.

"Some patients embrace it, but other patients are very upset to have to be here," she explains. "Fertility treatment is one of the most stressful experiences for any individual; you are impacted physically and psychologically. If it was anything else, you might sit with your best friend and it would all come out, but, quite often with fertility problems, people will not even tell their closest friends or family that they're going through the treatment." The Clane Fertility Clinic is housed in a purpose-built, yet unremarkable building, which looks like a simple office block.

There are no identifying features -- just a small sign on the large, green double doors with the words, "Press intercom wait momentarily then enter." In the reception, numerous frames hang on the walls, filled with photos of wide-eyed toddlers and newborns peeking warily into the lens.

Before I meet Martina, as I sit in the waiting room, all rationality, apparently, leaves me. I am nervous, the 'what if?' of such a visit, some day, becoming a reality for me, is suddenly overwhelming.

I leaf through some of the magazines on the coffee table -- women's magazines, fashion, gossip, celebrities -- anything to distract myself. In the end, I fixate on the flowers in the centre of the room, wondering, like, perhaps, many before me, if my eggs and my ovaries are fresh like these carnations, or wilting in there, unbeknown to me; getting ready to let me down, even before I've begun contemplating motherhood.

"A lot of the time, people can put fertility on the long finger and say, 'I'll get to that later.'" Martina explains a few moments later, as we sit in her office. "But, sometimes, then, the best years can be gone. Unfortunately, when it comes to fertility, so many women will look back and regret, and for patients, years down the line, that regret can harbour huge emotional problems and disturbances."

Clane is one of just two Irish fertility clinics currently offering women the opportunity to, potentially, put their fertility on hold through the flash-freezing or 'vitrification' of eggs.

"We're seeing many women interested in vitrifying their eggs that are in varying circumstances; be it that they're focusing on their careers, they haven't met their life partner yet or, perhaps, there is a potential of early menopause and they want to try and get the best for themselves," says Martina.

"While they might have a statistically low chance of achieving a pregnancy, there still is a chance and, for some people, regardless of what treatment they go through, it's important to know that you've done the best you can," adds Martina. "Sometimes, to have tried and failed is much easier for a patient to deal with, than to have never got the opportunity to try in the first place."

The process of egg-freezing, however, is no lunchtime jaunt. After initial checks and a thorough medical history, women must inject themselves with ovulation stimulants for two weeks prior to the egg collection, and get scanned every three to four days.

"Everyone's ovarian reserves are different, and the quantity and quality of eggs that every patient gets will also be different. For someone like yourself, in their 20s," Martina explains to me, "probably with a good ovarian reserve, we would be hoping that you would get approximately 10 suitable eggs.

"So you'd have conscious sedation, and it's done by trans-vaginal ultrasound. We pass a small needle into the follicles and we suck out the solution into the test tube, which we then pass to the embryologists, who look at them under a microscope, to see if we've retrieved an egg."

Some women will go through this process of harvesting and storing their eggs a number of times to increase their odds of motherhood and, the earlier they do it, the better. The current cost of the procedure, however, may act as a potential deterrent for young women, particularly in the current economic climate. Martina believes as egg-freezing becomes more common, the costs will align accordingly but, for the moment, the overheads are to blame.

"There is a huge amount of quality assurance involved," she explains. "We have loads of liquid nitrogen tanks, because that's what they're stored in, and we have to refill those at approximate times every week. We have a very sophisticated system within that where, should the temperature drop by even half a degree, it sends out an alert to all of the key people, so there's that constant quality assurance there and, unfortunately, those services are costly.

"We also have an electronic tagging system because, obviously, we are big on traceability; so it's clarification for the patient that 'they're my eggs' or 'that's my sperm', and it's reassuring. Security is huge, too.

"The whole of our unit is surrounded by complete vigilance and CCTV from all angles, and our building is good in that we are very discreet. Even people from the locality, unless they've been here, will not know what we are. It's precious cargo, you know?" Martina smiles, as she guides me into the clinic's cryopreservation room, where a number of large tanks line the walls.

"So, here we have eggs stored. We have donor sperm and we also have our embryos. Sometimes, coming in here can be a realisation for people," she adds. "They see it for what it is; the old-fashioned, baby-in-a-jar image can be misleading, so seeing it makes it a bit easier."

The basic nature of fertility treatment of any kind, however, divides opinion, and egg freezing not only sparks debate among us civilians, but it is also a major bone of contention among the Irish fertility community. Martina is aware of the opposition.

"We had to go through a very rigorous process in order to be able to carry out this process," she explains. "Our embryologist spent a lot of time in the US training and, if we were not confident in doing it, we wouldn't be offering it to people. Also, if we were to shy away from it, how would anything new get started?"

However, Dr John Waterstone, medical director of Cork Fertility Centre, and vice president of the Irish Fertility Society, believes that the Irish clinics currently offering egg-freezing are jumping the gun.

"Social egg-freezing certainly makes perfect sense, theoretically," Dr Waterstone says. The problems, he explains, are practical. "Unfertilised eggs are, technically, very difficult to freeze successfully so that, after thawing, they survive and remain viable.

"The process is only becoming acceptably successful over the past five years, and the progress is being made in the USA and in Spain in the context of egg donation, and not social egg-freezing.

"Fertilised eggs or embryos, in contrast, are easier to freeze, and have been used successfully for many years in IVF units all over the world, including in Ireland. No Irish fertility unit has yet frozen an egg, thawed it, fertilised it and produced a successful pregnancy."

While Dr Waterstone agrees there is an urgent need for egg-freezing in Ireland, particularly for women who require cancer treatment that might damage their fertility, until he is absolutely convinced it works, he will not be offering it as a paid service to any hopeful Irish "mums-to-be-someday".

"We are not prepared to offer our egg-freezing service to the public until we have frozen and thawed eggs, and produced enough pregnancies to be satisfied that the process is adequately successful in our hands," he adds. Up to 3,000 babies are now born in Ireland each year as a result of in vitro fertilisation (IVF).

Despite the initial hand-wringing and claims that the practice was nothing short of playing God, Irish people are availing of it, and any help necessary to have children of their own, in their droves.

For Helen Sweeney, 39, from Meath, the treatment was a godsend. "We've run the gamut, really. We got married in 2003 and I was 29. I never had any major history with problems; the usual kind of things, like I had a cyst on my ovaries as a teenager, but nothing ever came of it, so no major gynaecological problems," she explains.

"When we got married, we started trying straight away. We were together for a good few years before that and we both very much wanted a family. We tried for about a year on our own and nothing was happening."

At first, Helen was prescribed Clomid, a medication that boosts the chances of conception but, when that also failed, she moved on to intrauterine insemination (IUI) and immediately became pregnant.

"I had my first baby, a little boy, when I was 32 and that was great," she explains. "So we took a little bit of time with him, and we went back then when he was almost two. Obviously, everything went to plan the first time, so we decided to go with the same way again, but nothing happened."

Helen's desire for a second child almost became an obsession. "I found it very disappointing, so I went to see a counsellor," she says. "At that stage, I was coming up on 35, and we said we weren't going to be afraid of moving on to the next thing."

That next step was IVF, but, during her first course of treatment, her ovaries over-responded, putting her at risk of developing ovarian hyperstimulation syndrome, and it had to be abandoned.

"I can understand it now but, at the time, I was devastated," Helen tells me. "I found that utterly devastating. We took a break for a month, and came back then and, the next time, I completely under-responded. There was practically nothing. That floored me completely. I was so annoyed at myself. I was minding myself and doing everything right, and my body was letting me down. I had never experienced that before. It completely takes over your thoughts.

"I pride myself on being quite a grounded person and we did, to a certain extent, try to keep a life together, but we did talk about what if this didn't work? We would say, 'Well, we're very lucky to have each other', and everything, but I don't think either of us ever really believed that.

"It feels like a failure on the most basic thing that, as a woman, you should be able to do," Helen explains, the trauma of the period still very much with her. "It caused huge strain on our marriage and, when I say it took a toll, I mean it nearly broke us up, and we had one child at that point.

"We went for counselling and took a break for six months completely. We didn't think about it or talk about it, and tried to get on with life as normal. Then we went back when I was 36 and decided to try it again -- just one more shot -- and on that I got pregnant with my daughter." Helen's children, who are now aged seven and two and a half, are flourishing. "The major thing I came to learn is that having a baby isn't a right or an entitlement," she smiles.

"I think that's why some people find treatment very difficult, because you think, 'This is my right', but it's not. It's an honour and an achievement to get pregnant and to have a healthy baby."

Author Anne-Marie Scully, 32, wrote her first book, Motherhoodwinked: An Infertility Memoir, last year, documenting her struggle to conceive, and subsequent IVF treatments. Despite many difficulties, she hasn't given up on her motherhood dream. "I finished the book last December. I had just had a miscarriage after my second IVF treatment, and then I published the book on Amazon in February of this year," she explains. "I'd always wanted to have children and drove myself very early on in my career, quite aggressively in my 20s, because I wanted to achieve a lot before I actually had children."

Anne-Marie was 29 when she began trying for a baby, but, as the months passed, she started to fear the worst. "Each month becomes more and more pressurised, and the emotions get worse as the months go by," she says. "By six months, when it hadn't happened, I was worried, because I knew that I was young and healthy, and, by nine months, I was already starting to investigate my options."

Anne-Marie believes that many young women are hoodwinked into expecting "motherhood-on-demand".

"I think a lot of people suffer in silence and hope that a miracle will happen," she tells me. "I heard all of these stories about people who were maybe trying for five years and suddenly had a baby. I found hope in those stories, initially, but when I started talking to some of those people, I realised they had had IVF, they just hadn't said. I think people who have had IVF, like me, have a responsibility almost to say because, otherwise, people don't know how many other people have done it, and that they might need to look at it, too."

The fear of not ever having her own child is something that Anne-Marie has found particularly difficult, but these feelings have, simultaneously, fuelled her hopes. Hopes that are soon to be realised. Anne-Marie is now pregnant -- thanks to a third cycle of IVF -- and her baby is due on February 28. "It's very hard to describe the fear; that feeling of 'what if I never have my own child?''' she adds softly.

"There's something about parents, when they have a newborn baby; there's a sense of joy and complete bliss that you see on their faces, and there's a fear of never knowing that feeling, and never really being able to grasp that."

L

Irish Independent

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