Part Two In A Four Part Series About Fertility And How We Experience It
Sarah Bagg was 38 when she decided to freeze her eggs. “I’d kind of always thought, like a lot of women do, that I was going to have kids and it was all going to happen naturally,” she explains. Then, three years ago, after the breakdown of a longterm relationship, she decided she needed to take steps to preserve her fertility. “It was kind of part of my own healing process as well as being able to put a plan into action,” she says. “I went in for a consultation and when I came out, I just knew that I had to do it.”
The business development and marketing manager from Brighton, now 41, is one of a growing number of women freezing their eggs in the UK. The latest figures from the Human Fertilisation and Embryology Authority (HFEA), which regulates fertility treatment in the UK, show that since 2010, egg freezing has risen every year; in 2016, there were 1,173 egg freezing cycles completed – a 10% increase from the year before.
Discussions around egg freezing are also becoming more mainstream. When Bagg considered the procedure in 2015, much of the information was aimed at couples; she started a blog to address the balance. Now, celebrities including Brigitte Nielsen and Rita Ora have shared their experiences, while women discuss the topic on the podcast Eggology Club.
The process doesn’t come cheap – or with a guarantee of subsequent pregnancy. The NHS offers egg freezing to women who have reduced fertility as a result of cancer treatment but in most cases, you’ll need to pay to have your eggs frozen at a private clinic, where costs can be as much as £10,000.
Which leaves many women considering whether they can afford to follow suit – or afford not to. Is egg freezing an empowering way to offer women choice? Or an expensive luxury few of us can pay for or need?
There are three main stages to the egg freezing process: ovarian stimulation, egg retrieval and fertilisation. Much like with IVF, you first administer a course of at-home injections over around 10 days to stimulate the ovaries so they produce multiple eggs during one cycle. During this time, you’ll be monitored via regular blood tests and ultrasound scans.
“I'd kind of always thought, like a lot of women do, that I was going to have kids and it was all going to happen naturally."”
Next, eggs are retrieved via an operation, which involves a doctor retrieving the eggs by guiding a catheter through the vaginal wall – you’ll be under general anaesthetic when this happens. The eggs are then pre-treated with a solution and frozen with liquid nitrogen, before being stored in a secure environment. When you want to get pregnant, your eggs are thawed and injected with a partner’s or donor’s sperm. The resulting embryo is then placed into your uterus via a catheter.
Danielle Page, a 30-year-old writer who had her eggs frozen last year, says the question she’s asked most frequently about the physical process is “did it hurt?”
“It wasn’t painful as much as annoying to have to be home to inject at a certain time,” the New Yorker explains. “Towards the end of my cycle it did feel uncomfortable to have my ovaries feel kind of full – I imagine it’s what it feels like to be a cow that desperately needs to be milked.”
Page’s decision was prompted by hitting 30 and realising that while she had always presumed she’d have kids already, in fact her priorities currently lay elsewhere. “Turning 30 made me look back and reflect on what I thought I wanted back when I started this decade – kids, marriage – and what has actually made me most happy – a career, great friends and the freedom to hop on a plane at the drop of a hat,” she says.
You should freeze your eggs before you reach 35 to for the best chance of pregnancy after treatment, says Dr Victoria Walker, fertility expert at Institut Marques, a clinic specialising in assisted reproduction. “The younger the patient is, the better the survival rate and quality of the eggs.”
It’s usual to recommend freezing around 20 eggs, but doctors will alter this figure based on an individual, her age and current level of fertility. “It is really important to emphasise that egg freezing does not guarantee you will be able to conceive when you use the eggs later on,” stresses Dr Walker.
Due to the relatively new technology egg freezing utilises, the number of eggs frozen significantly outnumbers the number thawed and used, so there’s very little data around how successful conception is. HFEA figures show since 2010, just 471 babies have been born from frozen eggs in the UK, and the potential long-term impacts of treatment to both women and their babies are still unknown.
In the US, recent lab failings have also demonstrated the worst case scenario when eggs aren’t stored correctly: thousands of eggs and embryos may no longer be viable, following two separate equipment malfunctions earlier this year at fertility clinics.
Despite the uncertainty, women make egg freezing enquiries for a number of reasons, explains Dr Walker: many say they’d like to delay motherhood in order to pursue career aspirations, while others are yet to find a partner with whom they’d like to settle down.
“Turning 30 made me look back and reflect on what I thought I wanted back when I started this decade – kids, marriage – and what has actually made me most happy.'”
For Bagg, freezing her eggs allowed her to move on with her life. “I could have been wallowing in an ex relationship right now I think if I hadn’t taken stock and made a decision about what I was doing with my life,” she says. “But it’s an expensive way of moving on!”
The cost of freezing your eggs is significant. Page and Bagg managed to save enough money to pay for the procedure, but for many women this isn’t possible. The average cost of having your eggs collected and frozen ranges between £2,500 and £5,000, with egg storage costing an extra £150-400 per year, and fertilisation and transfer of the eggs around £1,000. In the UK, eggs can be stored for a maximum of 10 years, meaning the total cost could be as much as £10,000 - a figure hard to contemplate if you’re also facing record student debt and sky-high housing costs.
This financial strain means that private egg freezing “perpetuates social privilege”, argues Dr Angel Petropanagos, who specialises in feminist philosophy and bioethics at Dalhousie University in Canada. “It’s only a real option for a small group of women who are able to afford it... The cost can exacerbate existing inequalities by giving already privileged women more time to find pursue higher education, build a career, or find a suitable partner.”
The conversation around egg freezing may also perpetuate patriarchal norms in society, with its focus on why women “choose” to delay motherhood. Instead, says Dr Petropanagos, it could be highlighting how “existing social structures related to education, employment, and heterosexual childbearing and childrearing... unduly constrain women’s choices around reproduction”.
Companies such as Facebook and Apple have faced criticism for subsidising employee egg freezing – with some arguing that the deals pressurise women to delay motherhood, rather than force employers to create parent-friendly workplaces.
The financial inaccessibility of the procedure is also resulting in some British women traveling abroad to seek treatments that are “thousands cheaper”, according to Cara Nuttall, a partner at UK law firm JMW. Oversees deals are often a false economy, she warns, because the quality of clinics varies significantly, particularly around rules for egg storage. “Women should look into the clinic’s medical and scientific credentials,” she says.
Different laws, coupled with language barriers, can also leave women unclear about what they are signing up to. In some countries such as Thailand and Turkey, women must be married in order to use frozen eggs or undergo IVF – so if your situation changes, you may find you’re not entitled to use your own eggs.
In many places, you can get a cheaper deal if you also donate extra eggs to a bank, but the control you have as a donor varies from country to country. “In some countries it’s completely anonymous, while in others it isn’t,” Nuttall explains. Laws surrounding what happens to your eggs after you die can also differ, as can the maximum time you are allowed to store frozen eggs.
While the UK has robust legislation around egg freezing, Dr Kylie Baldwin, from De Montfort University, says there is one area in which it seriously lags behind: the maximum time your frozen eggs can be stored. Women who’ve elected to undergo “social egg freezing” are only permitted to store eggs for 10 years. In contrast, when a woman freezes eggs following cancer treatment, they can be stored for up to 55 years. Dr Baldwin is among a group of UK academics campaigning to get this law changed.
The law currently dissuades women from freezing their eggs at the biologically optimal time, argues Dr Baldwin. “Should a 28-year-old woman freeze her eggs, those eggs will need to be used or destroyed by the time she is 38, which is potentially right when she may need them the most,” she explains.
“Women can currently use donor eggs to conceive with no legal age limit in the UK on this procedure (although many clinics will not provide the treatment to women over 50). It therefore is unsound for women to be denied use of their own eggs to conceive, effectively being their own donor, especially as the donor egg pool remains low.”
Dr Baldwin would particularly like to see the law changed for women who choose to freeze their eggs for medical reasons such as endometriosis, polycystic ovarian syndrome, or a history of premature menopause or cancer in the family.
For cancer patient Charlotte Cox, founder of the London-based charity Lymphoma Out Loud, the opportunity to freeze her eggs long-term brought some relief at an extremely hard time. She was diagnosed with follicular lymphoma – an incurable type of cancer – in 2015 at the age of 26 and was told chemotherapy could make her infertile.
“The option to have this treatment provided me with something very positive and good in the very scary and difficult situation I was in,” says Cox. “I will always be grateful that I have such a caring consultant who thought about my future wellbeing and encouraged me to undergo egg freezing. During the process I also thought how lucky I was to be receiving this free treatment.”
Despite the support of her consultant, friends and family, Cox says she was surprised about how emotional she found the egg freezing process. “I was single and I had always imagined that when I started thinking about having children that I would do it the support of a partner,” she explains.
According to research from The University of California, San Francisco, one in six women surveyed who had frozen their eggs regretted their decision. Those who felt they had less emotional support at the time were the most likely to express regret.
The emotional impact was also what Page found so difficult. She explains: “My emotions were running so high due to the amount of [ovulation stimulation] medication I was on – my eggs weren’t responding well, so they had to keep upping my dosage. It was beyond any PMS symptom I had ever experienced, and even after my procedure, my lows felt extra low.”
When women consider the costs, the potential of failure and the implications on mental health, is egg freezing always the best choice? Is the best place for a woman’s eggs in a freezer, or in her body?
“I'm still not sold on whether or not I want to have kids, but I knew that I wanted the option."”
According to Dr Petropanagos, there’s no one clear answer, which is perhaps what makes the debate so difficult. “The best place for a person’s eggs depends on what they value and the amount of risk that they are willing to accept for themselves or others, such as their future children,” she says.
Neither Bagg nor Page are sure whether they will go on to use their frozen eggs, but both say they will not regret paying for the procedure. “I’m still not sold on whether or not I want to have kids, but I knew that I wanted the option,” says Page.
Bagg adds: “If I wasn’t able to [freeze my eggs], I don’t think I would have asked myself all the questions I have done in the last three years. I would still be chasing a partner to be a dad, rather than being happy in myself.”
This is the second part of a four-part series about fertility and how we experience it.