‘Botox for your womb,’ is how Joanne McNally pithily described egg freezing. Amid a pandemic spike in demand, Chrissie Russell speaks to women who have spent thousands freezing their eggs, meets Ireland’s first child born from egg-freezing and asks if the reality lives up to the sales pitch
The waiting room of a fertility clinic was the last place Laura Smith expected to find herself sitting in her early 20s. “I remember looking round and everyone around me was a lot older than me,” she recalls. “I felt like I was in the wrong place; that I was too young to be there.”
The young retail manager was there for a consultation at Thérapie Clinic, to find out what would be involved should she decide to go ahead and freeze her eggs. It was a point she’d arrived at when, having gone through four surgeries for endometriosis, her gynaecologist recommended an AMH test — an anti-mullerian hormone test — used to check a woman’s egg reserve.
“I had my first AMH test in 2020 and when I got my results back in 2021 [they were delayed because of Covid-19] they told me my reserve was very low for my age — that it was more like that of someone aged 38 or 39. It was very scary and overwhelming. I walked out of that appointment and burst into tears.”
At the start of 2022, Laura (24) had her consultation with Dr John Kennedy at Thérapie Clinic to discuss egg freezing. “I was still a bit doubtful and worried about putting my body through it,” she explains. “Then, I just thought I don’t want to go to have kids in 10 years’ time and be like, ‘I didn’t freeze my eggs, I have no chance of getting pregnant now’. So I did it more as an insurance policy — so I have the option.”
The egg-freezing insurance policy is one that an increasing number of women are buying into — whether prompted by health issues like Laura, or social factors like Eilish*.
“I never expected to be single at this stage of my life,” says Eilish (34). “I don’t think anybody does when they’re younger. You go to college, you meet someone, you get a good job. But things don’t actually work out like that.”
Eilish got an AMH test done in her 20s, prompted by a friend who’d experienced fertility issues. “I remember feeling really strange and odd doing it because the question was, why? You’re in your early 20s, you’re not trying to have a baby, why bother?
“I mean, the people who knew I was doing it were all very supportive, but there was always the fear that, outside that circle, if someone found out, they’d think, ‘oh, she’s mad to have a baby’, and that wasn’t the case. I just wanted to know [my egg reserve]. I like to have control over things if I can.”
It’s one of the reasons she prefers to remain anonymous for this article. “I’m 34, I’m still dating and if someone googles my name, I don’t want it to be the first thing that comes up,” she explains.
Eilish’s egg reserve was fine, and still showed no areas of concern when she repeated the AMH test 10 years later, but she decided she wanted to freeze her eggs anyway, and is currently on a third cycle of egg retrieval with the Waterstone Clinic.
“They estimate that, on average, you should have 15 eggs for one viable child and I got a bit over that on my first cycle, so I was really happy. But then I thought, what if I meet someone and we struggle to have children and I need to use these eggs? I wouldn’t do this twice on my own but if I was with someone, I would like to have more than one child.”
By upping her number of eggs in the bank, she feels she’s hopefully covering her bases for a variety of eventualities down the line.
“It still might not happen,” says Eilish pragmatically. “But at least I feel that I’ve done everything I can to make it a possibility. I won’t have any regrets or blame myself for not doing things I could have done.”
In a very short space of time, egg freezing has become a more talked about and pursued choice for women considering their options for having a child later in life. In Ireland, several clinics have reported huge increases in demand for egg-freezing consultations and procedures, with some rates doubling in recent years.
It follows the trend of a similar increase in demand elsewhere, including in the UK, where egg freezing has risen by 523pc in the past decade.
High-profile celebrity examples have played their part in the increased awareness around the procedure, with Kourtney Kardashian, Emma Roberts and Rita Ora just some of the many A-listers to speak candidly about the reasons behind their decision to put their fertility ‘on ice’.
Covid-19 has made its impact felt, too. A survey of the 380 patients who underwent testing or treatment at Waterstone clinics in the first six months of the pandemic revealed that 71pc of them felt Covid-19 lockdowns had given them more time to plan for a family.
Irish fertility clinic ReproMed has seen a steady 10pc increase every year in the number of egg-freezing procedures carried out at its Dublin and Galway clinics, and there was a 50pc increase in the number of egg-freezing consultations during the pandemic.
“There are a variety of reasons,” says Caitriona McPartlin, CEO of ReproMed Ireland. “Some women have not met a partner with whom they want to have a baby. Some have had an AMH test and it has shown that their egg reserve is on the lower side, so they freeze the eggs as an additional back-up in case they struggle to get pregnant in the future due to low ovarian reserve. Some want to defer having children until they or their partner are ready — sometimes for work purposes and other times for a variety of other personal reasons.”
With celebrities like Ora enthusing about egg freezing as “the best thing I ever did” or Jennifer Aniston poignantly ruing that no one had told her to “freeze your eggs, do yourself a favour”, it’s easy to see the procedure as a silver bullet — a desirable option for women faced with the ticking time-bomb of fertility.
But just how strong an insurance policy is it to have eggs in the freezer? Is the procedure bringing reproductive freedom to women, or further placing the burden of responsibility for family planning at their feet? Do advances in assisted fertility treatment represent greater availability of choice or a step towards the commodification of reproduction, where choice is only available to those who can afford it?
The egg-freezing process is similar to the steps involved in an IVF cycle. Treatment starts with medication to stimulate the ovaries and patients have ultrasound scans to track the development of the follicles in the ovaries as the eggs within them mature.
When the follicles reach the right size, an egg-collection procedure is arranged and the eggs are taken to the laboratory for vitrification, which is a specialised type of freezing.
A round of egg freezing in Ireland currently costs around €3,000, but additional consultations, medications, storage and subsequent cycles will often push that figure higher. Those choosing to avail of it as an option are predominantly young professionals.
Laura openly admits that, while she felt reassured by Thérapie’s reputation and presence on social media, price played a part in her choice of clinic. “Thérapie was the cheapest option that I found,” she says. The first consultation was free but she then spent €100 on a consultation with Dr Kennedy, €2,200 per round of egg retrieval, medication and freezing; she needed two rounds to secure a total of 12 eggs, the storage of which now costs her €18 a month.
“The amount of money I’ve put into this, it’s a lot of money. I’m spending all this money and what if it doesn’t work? I know I might not need to use the eggs but what if I do need to use them and they don’t work? There’s no guarantee.”
Eilish wouldn’t be having additional rounds of egg retrieval if it wasn’t for the fact that her work insurance package covers the procedure. “I got a new job with a company who support IVF and egg freezing, which is rare enough. It wasn’t the main reason why I got in with them, but it was a consideration.”
With events like egg-freezing parties now becoming common in New York and London — where clinics deliver information over cocktails and canapes — the procedure’s public image is very much in the same vein as accessible cosmetic work.
“It’s Botox for the womb,” quipped comedian Joanne McNally when she was announced as Thérapie’s first ever fertility ambassador last year. “At my age, you get everything frozen — your face, your eggs, everything.”
The egg-retrieval procedure only lasts around 20 minutes, definitely manageable in a lunch break, but it would be wrong to assume it’s easy, physically or emotionally.
“I found the whole thing a very lonely journey,” admits Laura. “That’s why I want to talk about it, because — even though I had so much support from my family, boyfriend, friends and the clinic — it was still like no one knew what I was going through. I had no one I could turn to and say, I’m crying over this, is this normal?”
Laura took tablets for 10 days then on to injections for another 12 or so days followed by a trigger injection for egg retrieval. “Then I went into the second cycle pretty much straight after. I didn’t want to let my body to get out of the way of the hormones too much. At the time I was a bit like, what have I done to my body? I’m usually quite a happy, bubbly person and I just felt like I’d lost myself a bit.”
Increased awareness around egg freezing is undoubtedly a positive, says Dr Kennedy, but more work needs to be done on making sure everyone knows what’s involved and the success rates.
“People think freezing is really easy and it’s not really easy, it’s hard,” he says. “Most women will have to go through more than one round of egg freezing to get enough eggs so that they would have a greater than 50pc chance of having a baby with those eggs. I think that’s where the next phase of education needs to be.”
A paper recently published in the journal Fertility and Sterility on research carried out by New York University Langone Fertility Centre, revealed that the overall chance of having a baby from frozen eggs was 39pc. Women who were younger than 38 when they froze their eggs had a 51pc probability of a live birth, while women younger than 38 who had frozen more than 20 eggs saw their chances rise to 70pc.
The age at which the eggs were used didn’t affect the outcome, but the age at which the eggs were frozen, and the amount frozen, did.
However, Dr John Waterstone, whose Waterstone clinic has links with the clinic in the New York study, is sceptical about how widely the results of the study can be applied.
“You can’t generalise; just because a clinic at the top of its game can get good results from freezing doesn’t mean every clinic can.”
Dr Waterstone has been at the forefront of assisted reproduction in Ireland for more than two decades and he’s frank in voicing his concerns around egg freezing.
“I was very nervous about this area and shied away from it for a long time because how well do we know it would work? How efficacious is it going to be? With social egg freezing, they go in the freezer and they might not come out ever, or they may not come out for several years — so how are you supposed to know how good the results are, when you don’t really have any results?”
He worries that rather than providing women with choice, it might impact negatively if they decide to delay conceiving, lulled into a false sense of security.
“If a woman almost assumes that it’s going to work in the future, she may delay getting pregnant later than she would have done otherwise and then, if the insurance policy, the frozen eggs, don’t work, you may actually have done her a disservice.
“There is an ethical concern about not helping women at all, but actually doing something that might be counter to the best way forward for them. It really has to be viewed as an insurance policy that may not pay out. You cannot rely on those frozen eggs and you certainly shouldn’t modify your reproductive choices [by] banking on those eggs.”
To illustrate just how new egg freezing is in Ireland, consider this — the first Irish woman to give birth using frozen eggs only did so in 2016.
“Yes, that was the big thing, I believe there was a big celebration in the clinic,” laughs Gillian Mulligan (47) mum to six-year-old Georgia Rose. She pauses, musing whether Georgia will one day be viewed as a major leap in science in the same way the first test-tube babies were.
“It’s a funny one,” she says. “But it’s not something I really dwell on or think about, really. I was just trying to have a baby.”
Trying to conceive using frozen eggs and donor sperm was just one step in Gillian’s long journey to conceive as a solo mum. Over the course of five years, the childcare worker spent more than €18,000 trying IUI (intrauterine insemination) and IVF, before an egg-reserve test prompted her do three cycles of egg retrieval and freeze the eggs collected. “I only got 10 eggs, which was not a huge amount,” she recalls. “And only one egg survived freezing and implantation.”
It was to become Georgia.
“Statistically, when you look at the percentages, I am really lucky,” says Gillian, who was a patient with ReproMed. “It was a long trek and I’m grateful for what I have. But the one thing I would say to everyone is to get your egg reserve checked early on.”
Greater awareness and education around fertility is something that fertility coach Helena Tubridy, author of Fertility In Mind: How To Succeed With IVF, feels strongly about. But she has concerns not only around the so-called insurance policy portrayal of egg freezing — namely, that there are so few guarantees around the quality of the eggs extracted and their potential — but also the wider societal implications.
“With companies providing egg freezing as a benefit, people might feel they’ve to stay loyal to that company because of it,” muses Helena, who recently completed an MA in the ethics around fertility treatment. “It seems like a way of retaining people that might not be entirely ethical. I’d prefer to see the system change to support women with childcare; support people in having children and being able to re-enter the workplace. I’d like to see the corporate culture shifting.
“I think it puts a huge burden on women to be the curators of fertility. Should women have to bear the brunt of fertility preservation?”
It’s hard to overlook the gender divide. More women are investigating egg freezing, but the same interest certainly isn’t being shown from men looking to preserve their sperm.
“I had a gentleman in recently who wanted to freeze sperm because having children is important to him, but he’s the first person I’ve seen without any clinical indication,” says Dr Kennedy. “But while there is a decline in sperm as you get older — and we’re learning more and more about this all the time — it’s not as bad as with eggs, and we’re better at treating male-factor fertility issues. Eggs are tougher to get and much more precious limited resources.”
And they’re becoming ever more precious. With more women looking to start a family later in life, the demand for young donor eggs is soaring. At the UK’s largest frozen-egg bank, London Egg Bank, women under 35 can freeze their eggs for free — but only half of the eggs harvested will be for their own use, the other half will be for donation.
If frozen eggs aren’t used, are they discarded? “Definitely not!” Caitriona McPartlin of ReproMed says. “We would try to encourage [clients] to pay the storage fee but we would ultimately make several attempts over a long period of time before we did dispose of them.”
Dr Kennedy of Thérapie concurs: “We wouldn’t just discard the eggs. We would engage with the patient to try to work out what was going on and whether they wanted to continue storing them.”
Laura knows she has a less than 45pc chance of conceiving a child from the eggs she has frozen. She still hopes to conceive naturally and it’s something she will start thinking about sooner rather than later. But she’s still grateful to the opportunity afforded by egg freezing, no matter the cost.
“Before I froze my eggs, I was thinking about it all the time, crying about it, wondering, what am I doing? Now, I feel I’m back to myself. It was hard, but it’s still the best thing I’ve done, the best decision for me right now.”
* Name has been changed