Fertility: will we ever win the egg race?
Published 13/04/2011 | 09:51
As the UK's first baby conceived from a 'flash frozen' egg is born, we look at the revolutionary treatment that is giving hope to a growing number of women who want to postpone having a child - and the drawbacks for those trying to slow their biological clock
In a fashionable bar in west London, a group of well-dressed, single women in their thirties are laughing over the woes of the day. Work traumas are swiftly dissected; gossip shared. As a second bottle of Sauvignon Blanc is opened, the conversation shifts to equally familiar territory: the search for a decent man, the cruelty of the biological clock, and how to handle fading chances of motherhood.
Into this mix Sarah, a 34-year-old chartered surveyor, tells the others that she is contemplating a major decision: having her eggs frozen, in an attempt to create an “insurance policy” against shrinking fertility odds.
It is not a bombshell. In just a decade since egg-freezing became legal in this country, for young women in 2011 the idea of putting their eggs “on ice” has now entered the mainstream.
Among this particular group of professionals, which includes a solicitor and a City trader, the notion has previously been discussed several times. Sarah has always wanted to have children. But since splitting up with her long-term boyfriend four years ago, she has been mainly single – struggling to meet anyone that she considers to be “relationship material”.
She is not alone. Research suggests one in three professional women are “involuntarily childless” by the time they are 40 – usually because they have not met the right man. Now, increasing numbers of women are attempting to stop the biological clock, by having their eggs frozen before the quantity and quality of their ovarian reserve suffers a further decline.
In the past decade, more than 6,000 eggs have been stored in the UK. While many have been harvested from women whose fertility has been damaged by treatment for cancer, increasing numbers are being stored for what are deemed “social reasons” – chief among them, the failure to meet the right man, or the priority given to a career and securing a home.
However, this is a back-up plan that comes with no guarantee. In this country, just seven babies have been born as the result of frozen eggs. They include Olivia Bate, revealed last weekend as the UK’s first baby to be born from an egg that was “flash frozen” – a pioneering technique that promises better results than previous methods.
Last Sunday, her mother Karen Bateman whose fertility was damaged by endometriosis, and father Carl Bate described their nine-year battle to start a family, and devastation when a previous IVF attempt failed. Although Miss Bateman is only 36, and the eggs thawed just five months after they were harvested, medics believe the success shown by the technique will offer hope to women who want to store eggs for many more years.
Miss Bateman, a chemist dispenser, said: “We know Olivia’s birth has made medical history. When she is old enough to understand, we will tell her how significant her birth has been.”
Days later, the 51-year-old daughter of Tory peer Lord Young gave birth to her first child, as the result of eggs harvested eight years ago, when Judith was diagnosed with cancer following two failed attempts at IVF.
On Thursday, her father, 79, a minister in Margaret Thatcher’s government, described the child as “a little miracle”. He said his daughter had struggled to have children after making “the classic mistake” of her generation by marrying late in life.
But can science offer a safety net to women who hope to preserve their fertility – and should it?
The experts are fiercely divided. Dr Gillian Lockwood, vice-chairman of the Royal College of Obstretricians and Gynaecologists’ ethics committee and medical director of Midland Fertility Services, which carried out the procedures that resulted in baby Olivia, says her birth demonstrates that “the technology works”.
She believes that in time, the development could hold as much influence over women’s fertility as the contraceptive pill.
A woman undergoing IVF at 40 who uses eggs frozen a decade earlier will have three times the chance of success as if she used her current eggs, she says.
“I’m reluctant to describe egg freezing as an ‘insurance policy’ because there is no guarantee,” says Dr Lockwood. “But if being a genetic mother is part of a woman’s lifeplan, and circumstances have not fallen into place, it certainly offers an option to consider.”
Eggs that are flash frozen – a process lasting less than 60 seconds – have a 95 per cent chance of surviving the thawing process, compared with 65pc via previous methods.
But egg survival is just the start; if a 40-year-old woman conceives using eggs frozen a decade earlier, the risks of miscarriage and genetic diseases such as Down’s syndrome will be the same as if she were 30 – a major advance. However, the only way to conceive with those eggs is by entering the IVF lottery, with a success rate of around 30pc per cycle; those odds are three times as good as if she were using her current eggs, as Dr Lockwood highlights, but a game of chance, all the same.
The same woman can expect to spend more than £7,000 (€7,846) on the costs of egg retrieval, a decade’s storage and one round of fertility treatment – whether or not it works.
That, clearly, is not the only gamble.
For most women contemplating the decision, the probability of success depends not just on those statistics, but on their own uncertain future; for many of those who go ahead, it means taking a chance on meeting “Mr Right”.
If the eggs are never defrosted, the bill will amount to around £3,000 ($3,362) for the process, plus about £200 (€224) per year of storage, until they are finally destroyed.
IVF pioneer Lord Robert Winston believes egg freezing for social reasons is “a giant confidence trick” being played on women seeking reassurance that cannot be honestly given.
He says clinics should not be allowed to offer the service unless for medical reasons – such as ahead of cancer treatment – or as part of a clinical trial.
“It is a con, it is as simple as that. It’s a jolly good way to make a lot of money out of women, but it is a truly terrible way for them to plan their families.”
In particular, he is concerned that not enough is known about the long-term health risks to those born through the process. While several hundred babies have been born worldwide as a result of freezing since the first case, in 1986, most have been born in the past decade.
“I think it should simply not be licensed in the way that it is at the moment,” says Lord Winston. “It seems to me the whole regulatory framework has failed in letting us get to this point; there should have been much more research on animals before we reached this stage.”
The peer and broadcaster says he is “deeply concerned” about the direction the IVF industry is taking. “Too much of what clinics are doing is exploitation, and it is driven by avarice.”
Fertility is certainly big business. This week Kensington Olympia in west London opens its doors to Fertility World – a two-day exhibition where clinics from cities such as Bangkok and St Petersburg will compete for fertility tourists seeking to go abroad in search of cheaper prices, and, more crucially, donor eggs; also at the exhibition Chinese herbalists will offer holistic supplements costing £160 (€179) per course of treatment.
It is an industry that trades on the quiet desperation of women who had always assumed they would one day have children. Meanwhile, the possibilities opened up by medical advances create yet more ethical dilemmas – chiefly, how old is too old for motherhood?
In the past decade, the number of women in the UK over the age of 40 having babies has already doubled, with 27,000 births in this group in 2009. Most IVF clinics in this country currently refuse to treat women aged 50 or over, though they can seek donor eggs abroad. And many women in their forties who seek IVF in the UK cannot be helped because of a national shortage of donor eggs.
If advances in egg freezing offer fresh hope to older women who want children, is society ready to see increasing numbers of mothers who reach pension age by the time their children finish school?
Dr Allan Pacey, a fertility lecturer at the University of Sheffield, says: “The interests of the child have to come first when decisions are taken to start IVF; that is what our legislation says. I feel fairly relaxed about more women having children when they are a bit older, but it’s quite a grey area and clearly as the age rises, more people feel uncomfortable about it. These decisions are ethical, not medical.”
While many women investigate the possibility of egg freezing, finding out about the reality of the invasive process and the uncertain rewards deters some.
The six-week procedure involves daily injections of ovulation drugs, which can cause water retention, hot flushes and weight gain, and carry risks, including ovarian hyperstimulation syndrome, a potentially life-threatening condition. Patients undergo a series of vaginal ultrasound scans and blood tests to monitor the developing eggs before their eggs are harvested under general anaesthetic.
Linzi Stoppard, 33, a professional violinist, who has been married for seven years to Will, 37, the son of the playwright Sir Tom Stoppard, consulted the London Bridge Fertility Centre two weeks ago to find out more about egg-freezing.
The couple, from Marylebone, in central London, are keen to have children, but in recent years her career as an electric violinist has taken off, with international tours as part of the rock band Fuse.
Now, she and her husband, who is also her manager, are contemplating putting her eggs “on ice” so they can make the most of those work opportunities.
“We would like to have a baby, but for the last few years my career has been the priority,” she explains. “In the entertainment business, when you are on a roll you have to go with it, and it is hard to see how it could combine with motherhood.”
While her friends can understand the couple’s perspective, both sets of parents are less convinced.
“I think both our families think we should just get on with it; that there’s never a good time to have a baby,” says Linzi. Following the consultation, the couple remain undecided; so far, even finding a window to undergo the six-week treatment has proved difficult.
Fertility experts say cases of women trying to stop the clock for career reasons are fairly rare; most of the women they see are single, hoping to secure a bit of extra time to meet the right man, or for a new relationship to become established.
“A lot of professional women find they have got a pretty narrow window to have children after getting on the career ladder, paying off the student loan and buying a home,” says Dr Lockwood. “Mostly, it’s not that they are climbing the greasy pole – it is that with everything else on, they haven’t met the right man, or a long-term relationship has broken down.
“The world is full of commitment-phobic men,” she adds. “I see a lot of women who say they were with a man for six or seven years that they thought was ‘Mr Right’ but then when they say they want to have a family it turns out the man was happy just drifting along.”
Polly Anthony*, who works in advertising, and lives in the south west, was 33 when she decided to have her eggs frozen. “I’d always had quite high-powered jobs and wanted to get on with my career, but that wasn’t the reason I hadn’t had children – I just hadn’t met anyone I wanted to settle down with, and I knew time was getting on,” she explains.
“I read about egg-freezing, and it seemed one way to take a little bit of control over a situation that was out of my hands; it felt like a back-up plan.”
Two months later, she met Edward*, whom she married last October. Mrs Anthony, now 36, says: “Once I had done it, I felt as though the pressure on me had lifted. Maybe it would all have happened anyway but it felt as though it freed me up to meet someone.”
Now, she feels “very excited and lucky” to be three months pregnant. The couple conceived naturally, but she remains glad she spent around £3,000 (€3,362) having her eggs harvested.
“It was the cost of a really good holiday, but to me it seemed a reasonable investment, and still does. We might still use the eggs in future, if I have difficulties conceiving when I am older.
“For me, it was always my Plan B – I just feel incredibly lucky that Plan A came off.”
* Not their real names