Putting Motherhood on Ice
Egg freezing offers women the chance to add years to their fertility -- but with no guarantees.
By Vince Beiser
In the brave new world of motherhood, women often find themselves in a dance accompanied by the sounds of their ever ticking biological clocks and their inner voices telling them to wait for their careers to either peak or slow down, find their true love, or give them a signal that now is the time. Fertility has always been on an undeniable timeline.
Until now. Growing number so women are turning to a new procedure that offers a change to stop, or at least slow, that clock: freezing eggs until they're ready to put them to use. Egg freezing -- oocyte cyropreservation, if you want to get technical -- sounds like a dream come true for many women, a way to even the playing field with men who can reproduce well into their retirement years. And it's a potential godsend for the approximately 50,000 women under 40 who are diagnosed with cancer every year, whose chemotherapy or radiation treatments are likely to leave them infertile.
It's no wonder that the practice, while still small, is growing fast in the US and around the world. Even celebrities like Jennifer Aniston and Janet Jackson are reportedly considering putting their gametes on ice.
But despite all the enthusiasm about egg freezing, at this point the process is neither guaranteed effective nor proven safe. It also raises vexing ethical questions, not least of which is whether the technology liberates women, or merely makes it easier for them to make yet another compromise in a workplace that isn't family friendly.
The Cryogenic Quest
It's now a woman's body in general that's to blame for declining fertility as she ages -- it's mainly her eggs. A healthy woman's uterus is perfectly able to carry a baby into her 50s and beyond. The quality of her eggs, however, starts dropping fast in her late 30s, and falls off a cliff when she reaches her 40s.
With that in mind, researchers around the work have sought ways to freeze eggs for years. Techniques for freezing sperm and embryos were mastered decades ago. The first successful birth from frozen eggs -- a pair of twins -- occurred in 1986 Australia's Flinders Medical Centre. The children were delivered by Christopher Chen, MD, who hoped the technique would provide an alternative to women with moral objections to freezing embryos. But scientists weren't able to reliably replicate the process.
The problem is that the egg is composed mostly of water. During freezing, that water forms ice crystals, which damage the egg's structure. The process also hardens the egg's "shell," making it difficult for sperm to penetrate.
Recent years, however, have seen a series of major breakthroughs. Techniques have been developed for protecting the eggs with various chemicals that prevent ice crystals from forming during freezing, and for injecting sperm through their hardened shells after they're thawed. A new method involving much faster freezing, called vitrification, now exists as well. These developments have significantly boosted success rates at some facilities to levels comparable for those of traditional IVF with fresh eggs.
Fewer that 1,000 women in America have frozen their eggs, most of them in the last few years. But the market is growing fast. A survey released in January by the cancer survivors' Fertile Hope found 309 clinics offering egg freezing -- more than double the number from three years earlier. The demand is certainly there: a study by the Center for Work-Life Policy found that a third of women aged 41 to 55 in high-achieving careers are childless, but only 14 percent of these women say they don't want kids.
To proponents of the procedure, egg freezing is the biggest step in empowering women to take control of reproduction since the birth control pill became widely available in the 1960s. "The pill was the great emancipator for women," says John K. Jain, MD, director of the recently-opened Egg Freezing Center in southern California. "I view egg freezing as the second round of emancipation."
The pill gave women the revolutionary ability to choose whether to get pregnant -- the freedom, in short, to postpone motherhood. That, in turn, made the pill one of the most important factors in boosting women's social and economic status. It gave unprecedented numbers of women access to higher levels of education and the ability to climb the career ladder. The problem, of course, is that by delaying pregnancy to take advantage of all those new career opportunities, many women end up waiting too long. Egg freezing, however, offers the prospect of having it all.
"In a way, egg freezing is like out generation's antidote to the pill," says Christy Jones, CEO and found of Extend Fertility, a network of clinics offering the process in several states. "We're all on it into our 30s, and then we suddenly discover it's hard to get pregnant."
Jones, for instance, had her own eggs frozen at 34, when she was single and hard at work starting up a new company after years in the software industry. She got married soon after; now at 38, she is expecting her first baby -- not from frozen eggs. "It took us a couple of years to conceive, though," she says. I'm glad I have those frozen eggs fro number two, or three."
It's a fact of our time that, on average, women are getting married and having children later in life then ever in American history. That's partly, of course, because of the explosion of opportunity in the workplace over the last few decades. Moreover, unlike their mothers or grandmothers, professional women aren't under economic pressure to find a man to provide for them -- they're perfectly capable of paying their own bills, points out Debora L. Spar, president of Barnard College and author of The Baby Business (Harvard Business School Press, 2006) a book that examines the growing business of reproductive medicine.
Jillian Straus, author of Unhooked Generation, (Hyperion, 2006) a book surveying Gen X'ers attitudes toward relationships, thinks the culture of infinite choice in which 20 and 30-somethings have grown up also plays a role. Young people are used to getting used to getting everything from their Starbucks coffee to the iTunes playlists custom-made to their specifications expect the same perfection in a mate, she says. "There are so many more options, opportunities and lifestyle choices today," says Straus. "It makes us much pickier." We're also the post-divorce generation. That makes us more skeptical of marriage." Both points go fro men as well, of course, women don't always end up childless in their 30's out of their own choice.
For "Sarah," a Los Angeles-based psychologist who does not want her real name printed, freezing her eggs was a way to get around her conservative Catholic family's objections to creating and freezing embryos, which they consider the beginning of life. At 37, she was ready to have a baby, but her boyfriend, six years younger, was not. Stockpiling her eggs yielded an unexpected side benefit. "It took a lot of pressure off -- that feeling that we needed to make a decision about our relationship within a time limit," she says. "We might have broken up otherwise."
But regardless of how appealing egg freezing may be to a commitment-averse generation, the American Society of Reproductive Medicine does not recommend it except for cancer patients. There just isn't enough data yet, says Marc A. Fritz, MD, a professor of obstetrics and gynecology at the University of North Carolina-Chapel Hill and chair of the ASRM Practice Committee.
Only some 500-600 babies worldwide have so far been born from frozen eggs, he points out, far too small a sample from which to draw definitive conclusions about its efficacy or safety. Operations like Extend Fertility or the Egg Freezing Center brag about their better-than-50-percent pregnancy rates, but those statistics are based on numbers of women barely in the double digits. "Currently there is no way for a program that offers egg freezing to provide a valid estimate of the prognosis for success, and without that basic information, there is no way for women to make a truly informed judgment regarding whether the technology can meet their needs and expectations," says Fritz.
Eleonora Porcu, MD, one of the world's foremost researchers on egg freezing, who has seen nearly 150 babies born from frozen eggs at her research facility in the University of Bologna, Italy, agrees that it's too soon for the technology to be marketed to women. "These labs want to earn money and they identified a business -- selling a dream to single, not-so-young women who want to stop time" she says. Porcu's own success rate is slightly more than one pregnancy for every 4 attempts.
The procedure is a gamble, and an expensive one. Extracting and freezing the eggs costs around $10,000, and storing them costs another several hundred dollars every year. "Molly," a lawyer in New York who did not want her name published, says she didn't produce enough eggs at first and had to go through a second extraction cycle. And there's no insurance coverage for any of these procedures.
How It's Done
The process isn't fun. The preparation involves nearly two weeks of hormone injections to boost the number of eggs produced in an ovulation cycle, along with frequent visits to the supervising physician. "Between the injections and the blood tests, my arms and legs were really black and blue," says "Molly."
The actual egg extraction is the easy part. At the Egg Freezing Center, housed in a brightly-colored office block on a busy street in Santa Monica, patients are put under general anesthesia while lying on an ordinary-looking ob/gyn examining table. Guided by an ultrasound machine, a doctor inserts a vaginal probe equipped with a needle that punctures the follicles containing the patient's eggs and sucks them into a tube. The tubes are then passed through a tiny door to a sterile lab, where an embryologist loads them into plastic straws and puts them into the cryopreservation device, an innocuous-looking gadget that resembles a well-kept rice cooker. There, the eggs are dehydrated, loaded with anti-crystallizing cryoprotectant and cooled to -196oC. Now metabolically inactive, the eggs are stashed away in small steel tanks filled with liquid nitrogen to await the day when they'll be taken out and fertilized.
So far, there's no indication of increased pregnancy complications or birth defects associated with frozen eggs. But there are risks. The hormone shots can trigger ovarian hyperstimulation syndrome, which can involve nausea and abdominal pain. It's a rare complication, but in extreme cases can be fatal. Women who become pregnant in their mid-40's or after also have a higher chance of developing conditions such as preeclampsia, diabetes, and hypertension--although as long as they are healthy to begin with, those risks are small.
Some critics worry that egg freezing will boost the number of already-growing numbers of new parents in their 50s.
It's what we don't know that is potentially more serious. "There are tremendous unknowns," says Arthur Caplan, PhD, chair, department of medical ethics, University of Pennsylvania. "With frozen eggs you risk damaging the cell -- you don't know if you'll damage its DNA. If the process involved a 5 percent change your kid would be born with a serious birth defect, you'd want to know that. But we won't learn about small risks like that until there are large numbers of babies born from frozen eggs."
There's also a possibility that some women may skip trying to get pregnant in their 30s because they figure they can count on their frozen eggs. "The biggest risk in my mind is of not having a baby," says Dr. Jain. "Even though they're told what the success rates are, a lot of women still think 'Thank God, I'm going to have my own baby!' So if you haven't gotten pregnant by 42 and then the frozen eggs don't work, it's a big deal."
To some extent, the controversy echoes the one that surrounded the introduction of the birth-control pill. Spar, however, doesn't think the impact of the two technologies will be comparable. The pill was a watershed event," she says. Egg freezing is part of a continuum, with IVF and donor eggs. And, unlike the Pill, it won't be an option for large numbers of women because of cost.
A Good Choice?
For Porcu, the bigger the issue is why women, apart from cancer patients, should even feel the need to freeze their eggs. "Women give up getting pregnant when they're younger because in many jobs, it's unacceptable to be pregnant or have kids," she says. "It's really unfair. Women should change this attitude, not be compelled to freeze their eggs."
"Sure, it would be great if the rules were changes to make it easier for women to have children without sacrificing their careers," counters Extend Fertility's Jones. "But meanwhile, what are you going to tell a 36-year old woman who just got divorced because her husband cheated on her, who wants to have children but has to put her life back together first? "Sorry, you shouldn't have options?"
Critics and boosters alike agree that the practice is sure to continue growing. But given the uncertainties involved in egg freezing, it's very much a caveat emptor procedure. "I'd ask a lot of questions before I put any money down," says Caplan. "Women should be clearly informed about the possibility that it won't work."