Since Apple and Facebook announced their egg freezing initiative for female employees, the media has been awash with stories on the subject. The rationale behind the policy is that by freezing their eggs women are preserving their fertility enabling them to delay parenting and provide them with a sense of security. Sadly, the headlines that ensued have had the opposite effect and have only served to drive fear into the hearts and wombs of women everywhere. "Women warned to have babies by 30"; "Fewer than 50 babies born from egg freezing", scream the headlines. In order to create a good story the media focus on the extremes - whereas reality often lies somewhere in the less sensational middle. What might begin as an important message soon loses its meaning via an extreme or simplistic headline.
With National Fertility Awareness Week now upon us (2-8 November), a newly commissioned survey looked at attitudes towards egg freezing. We found that 25% of women would consider freezing their eggs, with this figure rising to 34% in the 25-34 age bracket. However, many people do not understand the difference between egg freezing and embryo freezing. Egg freezing is when eggs are extracted from a woman after stimulating drugs - the same ones used for an IVF cycle - help her to produce multiple eggs. These eggs are frozen via vitrification, a more efficient and successful method of freezing developed relatively recently. The eggs remain frozen until she is ready to start a family, at which stage they are defrosted and mixed with sperm in a petri dish in the hope that the sperm will fertilize the eggs and create embryos. One or more of these embryos can then be transferred into the woman's uterus where they will, hopefully, implant and become a fetus. This procedure is used to preserve fertility during cancer treatment and also, more recently, as a way of delaying parenting.
Embryo freezing is more common, having been performed as part of standard IVF cycles for many years. The procedure is the same but, instead of being frozen before being mixed with sperm, the eggs are fertilized by the sperm in the petri dish, the embryos created, and then frozen. These embryos - often spares or extras created as part of the IVF cycle - can be defrosted and transferred at a later date if the first cycle of IVF fails or for the couple to extend their family after a successful pregnancy. There is plenty of data on frozen embryos and many children have been conceived in this way. In recent years, vitrification has resulted in more embryos surviving the freezing and thawing process. We have much less data on egg freezing than embryo freezing; the hope is that it will one day offer women the chance to delay parenting. But the data from other countries looks promising with Spain showing 80% of eggs survive the thawing process and a 30% live birth rate. The likelihood of egg freezing being successful is dependent on the age of the woman when her eggs are frozen. Freezing eggs in their late 30s may not offer women the protection or security they seek.
Of course the original messages behind the press reports are sound; fertility does decline with age and the older we get the harder it is to have a baby. But not every woman is in a position to have a baby at 30 and scaremongering only serves to add more anxiety to an already fraught situation. Anxiety is the enemy of fertility. And there are important messages that rarely make headlines; i.e. there are alternative ways we can preserve our fertility, other than freezing our eggs.
1) Ovulatory problems are the largest cause of infertility. Without ovulation no egg is released and there is nothing for the sperm to fertilize. PCOS [polycystic ovarian syndrome] is the most common cause of infertility. Understanding your menstrual cycle and engaging in your gynaecology earlier in life is an important step to safe guarding your fertility.
2) In Chinese medicine, the age of your mother and her general health at the time of your conception impacts on your own fertility. Research demonstrates that the age at which your mother went into menopause is significant in gauging the likely age your own fertility will decline. Ask her about her fertility history - it may hold some answers.
3) Protect yourself from STDs; chlamydia and other sexually transmitted disease are believed to be the biggest cause of tubal infertility (16-24%). Protecting yourself from these diseases is one of the best ways to preserve natural fertility.
4) Keep your weight in check; ideally between 19-24 BMI. BMI is still used to assess suitability for IVF since BMI outside of this range is associated with miscarriage, sub-fertility and poor IVF outcomes.
5) Worldwide smoking is responsible for 13% of infertility cases. Don't smoke.
6) BPA, found in soft plastics and food packaging, are known as endocrine disrupters. Research suggests that they reduce sperm quality and sexual function, as well as potentially impact on egg quality in women. There is very little discussion about the impact of environmental factors on male and female fertility but it is likely that this is a factor in the increase in male factor infertility and in women conditions such as endometriosis and PCOS. Reduce your exposure to soft plastics as much as possible for three months prior to trying to conceive and switch to more natural cleaning products in your home.
Freezing eggs may well become the norm for women wanting to delay parenting. However, it is important to highlight some of the other aspects of how to engage and preserve our fertility. If egg freezing is to become commonplace, it is vital that it is not oversold. It needs to be a solution and not part of the problem. Freezing our eggs is not a safety net that allows us to remain ignorant to all the other aspects that impact on our health and fertility. Eggs are only one small part of what makes us fertile or infertile. Not everyone will be able to have children before they are 30, but everyone can take steps to protect their fertility. Pass this message on to a younger person in your life; fertility is precious, it does not last forever and is something to be valued and preserved.