When Emma Kershaw, 25, woke up, a number was written in black ink all over her body. On her hands, her arms, her legs, her feet. Yet it wasn’t the ink itself that confounded her; it was the actual number. Two. Just two. She knew she’d be wearing a number when she came around from the anaesthetic. That figure would represent how many viable eggs her fertility team had extracted to be frozen. She was hoping for at least 10, a magic number of sorts; one that experts consider to be both realistic and offer good odds of future success.
At the sight of two, Emma was devastated, but not as devastated as she had been just a few weeks previously when her gynaecologist had predicted her body would go into menopause by age 30.
“The day I found out was just the worst of my life,” Emma recalls. “It was a massive shock.”
Her specialist was quick to recommend she freeze her eggs to help protect her fertility. The Gold Coaster was almost as quick to act, completing the procedure just one month later. “It definitely wasn’t a hard decision to make,” says Emma. “I’ve always wanted kids … it’s just nice to know I have that back up just in case.”
Fertility on ice
A little background reading: egg freezing, or oocyte cryopreservation, is a method of storing a woman’s unfertilised eggs in an attempt to preserve her fertility. First performed in the 1980s, the process has long been used for health reasons; in particular, by women diagnosed with cancer who want to conserve their fertility ahead of treatments known to damage the ovaries, like chemotherapy and radiation.
Like a soccer game, the process is performed in two halves. Eggs are collected from the patient’s ovaries transvaginally, as with IVF, before they are snap-frozen. Later, when the patient is ready to become pregnant, these eggs are thawed and, if successfully fertilised, transferred to the uterus as an embryo.
The rapid-freeze process, known as vitrification, has been a game-changer. A vast improvement on its predecessor, it eliminates the risk of ice-crystal formation that can damage eggs. In fact, egg freezing was “virtually non-existent” in Oz before vitrification turned up “about three or four years ago”, according to Dr David Knight, medical director at Demeter Fertility, Sydney.
Professor Kate Stern from Melbourne IVF says the improved technology has given both fertility specialists and women more confidence in the procedure.
“Twenty years ago, for every 10 eggs you froze you might have only got two that would actually survive,” she says. “Now about 85 to 90 per cent – in some studies even up to 95 per cent – will survive the freezing/thawing. Once they’re thawed out, they behave almost exactly like fresh eggs, so they have approximately the same fertilisation rate and implantation rate.”
All women are born with a finite number of eggs, the quantity and quality of which decline with age... tick-tock, tick-tock. In a 2013 study by New York University of women who’d frozen their eggs, 88 per cent gave not having a partner as the reason behind their choice.
Aside from the emotional weight, Emma says the physical process of egg freezing is straightforward, with little to no pain or side effects. The process charts a similar path for all women. Following medical and psychological counselling, the patient begins a course of hormone-stimulating meds (delivered via self-administered injections) aimed at maxing the number of eggs that can be extracted.
Blood tests and ultrasounds monitor the egg follicles and, once they’re deemed big enough (usually after about 10 to 12 days), an injection triggers ovulation. The eggs are collected 36 hours later under anaesthetic using a fine needle attached to an ultrasound-guided probe. The needle passes through the vaginal wall and into the ovary before extracting the eggs. Specialists quickly work out the number of viable ones.
That figure is often written on the patient, as in Emma’s case, eliminating the anxious wait at the other end of the anaesthetic. The average yield from one cycle? 10 eggs. Although there are many variables, it’s suggested total collection of 20 offers the best chance of future pregnancy – data from Melbourne IVF defines this ‘chance’ as 30 to 50 per cent of pregnancy.
It’s not uncommon for women to go through multiple extraction cycles to improve their egg tally – although there are limitations, explains fertility specialist Dr Devora Lieberman from Sydney’s Genea clinic.
“There’s always going to be a ceiling beyond which more eggs won’t help and that number’s probably somewhere between 15 and 20,” she says. “If you really want to give yourself the best shot, you want to have 15 to 20 eggs or three stimulated cycles – whichever comes first.”
The thawing process, Stern explains, usually involves defrosting between six and 10 eggs, then injecting each one with sperm from the patient’s SO or a donor. All going well, at least one viable embryo will be created, which is then transferred into the patient’s uterus. Additional embryos can be refrozen. As with naturally occurring conception, the outcome is then a matter of fate.
According to the American Society for Reproductive Medicine, the chance of a single frozen egg leading to a live birth is between two and 12 per cent. So a lot of energy is invested in ensuring women never get the impression that freezing their eggs secures their future, says Stern.
“The biggest side effect (of egg freezing) is if women think ‘oh great, I’ve got these 20 eggs, I don’t have to worry’ but the words I always use are ‘this will give you, at best, a small additional number of opportunities’. Compared to not doing it, you should be a bit better off, but it doesn’t guarantee you a baby.”
Cold, hard cash
While the cost has decreased in recent years, egg freezing remains a significant dollar commitment. Prices vary between clinics, but tend to fall between $7000 and $11,000 for a round. Doctor’s bills, medication and storage costs are often in addition to this, as are expenses at the thawing end of the process.
This ain’t pocket change.
Medicare rebates are available, but only for patients considered medically infertile. Financial relief is more significant in places like the US where some organisations, including tech giants Apple and Facebook, help fund the freezing of employees’ eggs in an effort to attract and hold onto female staff. Programs like this have been criticised for perceived coercion – the assumption that women would freeze their eggs to prioritise their careers.
In fact, the stereotype of the career-driven egg-freezer is largely a myth, according to a 2016 study from De Montfort University Leicester. Although completed by a small test group, the survey found not one woman went through the procedure for career reasons. Stern also dismisses the idea. “The percentage of women who just want to delay things for their career is minuscule. The people that come and see us mainly are women in their mid- to late-30s or early 40s for whom life hasn’t turned out the way they wanted it to.”
Meanwhile from her three rounds, Emma has 19 eggs in storage. Whatever the odds, she hopes she never needs to make a claim on her ‘insurance’. Time is on Emma’s side. Early menopause affects fertility, but not a woman’s ability to carry a child. Regardless, the medical receptionist has always imagined having kids before 30 and, although currently single, still hopes to realise that dream.