Editor’s Note: This story is part of an ongoing series. For prior Baby Chase stories, see hudsonreporter.com.
Originally a technology created for cancer patients who hoped to preserve their family options while undergoing radiation treatment, egg freezing is now becoming an option for women who may not have met the right partner early in life, or who for some other reason want to make sure they can still have children after their eggs get older. And one fertility clinic in Hoboken is boasting improved success rates with the relatively new procedure.
Cryopreservation – the process of cooling and storing cells, tissues, or organs at very low temperatures to maintain viability – is not, in general, a new idea in fertility. Human embryos have been frozen for preservation since the 1980s and human sperm has been routinely frozen since the 1950s.
These days, it’s the attempt to freeze human eggs that is a hot topic. It is a procedure that an article in the May 2011 issue of Vogue magazine anticipated may be “the most significant social change since the advent of the Pill.”
“It’s definitely better than sitting around worrying and wondering, or even making a bad decision about finding a partner.” – Susan, 42
Keeping options open
Cindy Lucus, director of marketing at IRMS, said that because egg freezing is elective and usually not covered by insurance, the majority of their clientele are those who can handle the cost – sometimes more than $10,000 per cycle. At IRMS, most of the egg freezing clients are working women in their early 30s who have no partner, or those who got married in their late 30s but don’t want to put the pressure of having a baby on their new marriage right away.
While women’s reproductive organs may be able to carry a child even past their 40s, the older eggs that are fertilized are often damaged in some way. According to the March of Dimes, a 25-year-old woman has a 1 in 1,250 chance of having a child with Down syndrome, a disorder characterized by birth defects and mental retardation, caused by an extra chromosome. A 40-year-old woman who gives birth has a 1 in 100 chance, and a 45-year-old woman has a 1 in 30 chance. Many other pregnancies at that age will end in miscarriage, and the chance of getting pregnant in the first place at that age decreases rapidly.
One patient at St. Barnabas said she chose egg cryopreservation because she wants to have children someday, but doesn’t have a partner right now.
Susan (actual name has been changed to preserve anonymity) said she would not prefer to be a single mother, but she wants the option to have children of her own if she doesn’t meet a partner in time.
“I feel very fortunate that I live in a time that I can do this,” said the 42-year-old medical professional.
Last year, she completed four cycles of egg retrievals and was able to bank 20 eggs, which doctors have told her was a very successful outcome for a woman her age.
But the cycle isn’t complete until a frozen egg is one day used to create a healthy newborn.
Susan said she was thinking about undergoing another retrieval to bank more eggs.
“As long as I’m able to pay for it, to me, it’s worth it,” she said.
Susan estimated that each retrieval procedure, including medication, has cost her approximately $12,000 out of pocket – it isn’t covered by her health insurance.
“There are no guarantees,” she said. “But it’s definitely better than sitting around worrying and wondering, or even making a bad decision about finding a partner for the sake of having a baby.”
Searching for success
To date there have been over 1,000 births nationally as a results of frozen eggs. About 600 of those were in the past three years.
“The number is definitely increasing,” said Lucus, “[as women] become more informed about it and as our pregnancy rates from frozen eggs keep improving.”
Dr. Margaret Graf Garrisi of IRMS said that the research is still underway to determine the success rates of egg freezing.
To help move that process along, in 2008 IRMS began a research projects of its own, offering a full range of assisted reproduction treatment for a nominal charge to volunteer participants who went through the full cycle of egg retrieval, cryopreservation, and (after a short period of cryostorage) thawing eggs followed by insemination, embryo development in vitro, and embryo transfer.
According to the IRMS website, over 50 percent of in vitro fertilization (IVF) programs in the United States offer egg freezing, but far fewer programs have reported successful pregnancies after the thaw, averaging only about 10 percent per cycle.
However, IRMS reports a 35 percent ongoing pregnancy rate since the inception of their program. According to Dr. Garrisi, there is room to improve that number with each passing day.
“It’s so new,” she said. “Things change so rapidly, this is really just the beginning.”
Garrisi said that although today egg cryopreservation might be something that her 25-year-old daughter merely considers as an option, by the time her grandchildren reach the same age, cryopreserving eggs could be a routine procedure for a woman.
The ‘egg bank’ effect
An additional area that cryopreservation may have an effect on in the future is the donation of eggs from one woman to another.
Many women who can’t get pregnant on their own, and don’t have a good chance with IVF using their own eggs, can pay to have eggs implanted from a younger woman. The success rates of pregnancy with donor eggs are sometimes 60 percent or higher, whereas IVF rates with a woman’s own eggs are sometimes in the teens.
Currently, almost all eggs donated by women for others to use are fresh, but “egg banks” similar to sperm banks may be on the rise soon.
“We are only just now at the point where technology has made egg freezing viable enough to start the process of freezing donated eggs,” said Lucus. “We do see egg banks becoming more and more common in the future.”
According to Lucus, IRMS conducts a few dozen (around 45 to 65) egg donor cycles per year, but there are other programs that do close to 200 donor cycles per year.
Pressing pause on the biological clock?
Garrisi said that because so much of cryopreservation is dependent on the quality (which in fertility terms often means youth) of the specimen, for embryos or eggs it usually is not recommended that patients over 40 freeze their eggs.
“Success is based on three things,” said Garrisi. “How well the woman responds to fertility medication, how good the lab is, and the age of the person who made the egg.”
She said it’s important for women to consider the option of elective egg cryopreservation early.
According to The Center for Bioethics and Human Dignity, the ethical concerns presented with egg preservation include the potential for exploitation through egg harvesting, delaying childbirth past reproductive age, and the introduction of a “third party” into the marital relationship through potential increased egg donation with the freezing technology.
However, even a positive outcome is noted on their site as well – the increase in cryopreserved eggs is anticipated to lead to a decrease in cryopreserving surplus embryos created in IVF cycles, thus leading to a decrease in embryos that are discarded.
According to Dr. Garrisi, the expansion of research and technology for egg preservation actually stemmed from predominantly Catholic countries and Italy in particular, as scientists responded to a government ban on freezing and ultimately destroying unused embryos.
It was only just a few years ago that scientists in the United States took note and further advancements began to be made.
Around that time, in 2005, an article in New York Magazine profiled women who were making the choice to have their eggs frozen in a story called “Is egg freezing the next big thing for New York career women facing infertility?”
“I think a lot of decisions women make will change because of egg freezing,” said a 37-year-old woman in the story, who noted that despite going on lots of dates and hoping for marriage, “Finding someone who is ready for a commitment when you’re ready is very tough.”
IRMS will hold two “open houses” this week, one on Tuesday night in Hoboken and one on Wednesday in Clark, for women considering donating their eggs. See their website, sbivf.com, for more information. The site also includes a message board where women can post any question on fertility, ivf procedures, and related matters.
For those considering going a different route and adopting a child, the United Synagogue of Hoboken will sponsor a free “Intro to Domestic Adoption” session on Feb. 16 at 8:30 p.m. (To read the Reporter’s article on adoption in the “Baby Chase” series, see the archives at hudsonreporter.com.)
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How it works
Officially known as oocyte cryopreservation, egg freezing allows women to preserve their own eggs now without needing the sperm to create an embryo.
But unlike sperm and embryo cryopreservation, the outcome of egg freezing is still relatively unknown due to a lack of research and real life results from actual eggs that have gone full cycle in the cryopreservation process (from freezing through birth of a healthy baby).
One of the biggest challenges to egg cryopreservation has been due to the fact that the egg, the largest cell in the human body, is composed of a lot of water. When frozen, the ice crystals that form can destroy the cell. To prevent this from happening, the eggs undergo a vitrification process that adds a protecting agent and then the eggs are rapidly frozen to prevent the formation of ice crystals.
To get those eggs in the first place, the ovaries are stimulated through the use of fertility medications so that as many eggs as possible can be harvested.
The eggs are then cooled and stored until ready to be thawed and used.