February 08, 2015
The Globe and Mail
As more Canadian women turn to egg freezing to focus on building careers or as they wait for the right partner, the Globe’s Carly Weeks explores the fertility business, its procedures, and promises that might be too good to be true.
April Gore wants to be a mother. She just doesn’t know when. But once she’s ready, the 28-year-old wants to carry her own child into this world.
For years, Gore, an aspiring medical student who lives in Langley, BC, has feared she’d never experience what it’s like to be pregnant, to lose sleep caring for her newborn baby, to watch him or her grow. It’s an increasingly common worry for women in their 20s and 30s who are unsure of when they’ll be ready – psychologically, financially, or otherwise – to become parents. In Gore’s case, the anxiety was amplified by cysts that cost her one ovary and threatened to destroy the other.
She took matters into her own hands. Last year, Gore underwent weeks of hormone injections and two surgeries to harvest a dozen mature oocytes, or eggs, and paid to have them specially frozen. They’ll remain that way until she decides to use them. “Now that I have this safety net, I’m going to go pursue my dreams,” she said, noting that travelling and then attending medical school are at the top of her list.
Major medical advances and vastly improved success rates are quickly bringing egg freezing into the mainstream. Last fall, Apple and Facebook made headlines by adding egg freezing to their roster of employee benefits, and it’s expected more companies will follow suit.
Instead of just waiting for the right time to put their careers on hold, or wondering whether a great partner and potential father might come into their lives, women are seeing egg freezing as a way to buy time.
But there are questions about what exactly women are buying: are there any long-term side effects from the punishing regimen of hormones and medication needed to mature and harvest eggs? Does delaying motherhood simply defer the complicated issues of careers and child care to a later date? And, when all is said and done, will those eggs ever result in the birth of a real live baby?
Don’t expect to find the answers in the waiting-room pamphlets of fertility clinics.
“There’s an ugly side to this business,” said Dr. Beth Taylor, co-founder and co-director of the Olive Fertility Centre in Vancouver. “For many women, it can preserve their fertility until later in life. For many women, it doesn’t actually work.”
Until very recently, the debate over egg freezing was largely theoretical; the methods used were not sophisticated enough to keep many ultra-delicate eggs alive during the thawing process. As few as 10% would survive unfreezing. Of the handful of eggs that were left, only a small fraction could be successfully fertilized, implanted, and result in a viable pregnancy.
Back in the 1990s and 2000s, eggs were suspended in a type of anti-freeze and frozen gradually, explains Dr. Arthur Leader, co-director of the Ottawa Fertility Centre. While that method works well for sperm, it became clear that eggs, because of their high water content, were much trickier to work with. Because the technology was so limited, egg freezing was mainly used for women who had cancer and wanted to preserve their fertility after treatment.
Scientists then developed a much more successful method, called vitrification, which flash-freezes eggs and encases them in what looks like a pane of glass. (That’s how Gore’s eggs were frozen, and now they’re being kept at -196 C in a specialized tank of liquid nitrogen. All in, egg freezing will cost her about $10,000, plus yearly storage fees.) With vitrification, up to 90% of eggs now survive the freeze as well as the thaw.
The development of this process prompted the American Society for Reproductive Medicine to reconsider its stance on egg freezing. In October, 2012, the society declared that oocyte cryopreservation should no longer be considered experimental. It was a landmark decision that opened the door to the wider commercialization of egg freezing to women worried about their future prospects of conceiving. Last year, the Canadian Fertility and Andrology Society followed suit, agreeing it should no longer be labelled experimental.
Now, fertility clinics across Canada have added oocyte cryopreservation to their rosters of reproductive technology services. And word is spreading. Doctors at various clinics told me that inquiries about egg freezing are increasingly coming from women in their 20s and 30s. No one tracks how many women have had their eggs frozen in Canada, but one busy Toronto clinic reports that several dozen have approached it to undergo the procedure in the past few years.
The appeal of egg freezing is clear: when it comes to something as important as the decision to have children, why not invest in a little insurance for the future?
The catch is being able to collect on that policy.
Strikingly, one of the world’s leading reproductive-technology associations warns against using it as a way to preserve a woman’s fertility beyond her natural reproductive years. While the American Society for Reproductive Medicine (ASRM) lifted the “experimental” label, it warns in the same document that because so little is known about the potential risks and long-term impacts, egg freezing should not be routinely offered to women worried about their future fertility.
The ASRM examined the research and reported that few high-quality studies exist. It could only find four randomized controlled trials, considered to be the gold standard of medical research. The results showed that over all, 91-97% of vitrified eggs survive warming, 71-79% were successfully fertilized, 17-41% were implanted, and the clinical pregnancy rate per transfer was 36-61% per cent.
Those figures are similar to the success rates of IVF with fresh eggs, the society noted. But there are concerns that the positive results could be conflated. For instance, the society notes clinics likely publish studies only when the resulting pregnancy rates are high.
The society also highlights other risks. There is, for instance, little to no data on the long-term impact of harvesting eggs from women in their advanced reproductive years and implanting them a few years later as those women enter their 40s. And in addition to the short-term impacts of hormone injections and the risks that come with any surgical procedure, the retrieval of eggs can cause some women to develop ovarian hyperstimulation syndrome, a painful condition in which the ovaries are enlarged. Some research has also linked ovarian stimulation, needed to harvest eggs, to ovarian cancer, although the results have been conflicting.
“My main concern is that people understand that this is an expensive insurance policy on which they may get no return,” says Dr. Françoise Baylis, Canada Research Chair in bioethics and philosophy at Dalhousie University in Halifax.
The ASRM also warns against egg freezing in healthy women, “because there are no data to support the safety, efficacy, ethics, emotional risks and cost-effectiveness” of it.
Women might not be getting that full picture, which is what concerns experts such as Taylor. Although she runs a fertility clinic where egg freezing is offered to healthy women, Taylor is upfront about the fact those eggs will result in the birth of a live baby in only about 50 per cent of cases.
Many fertility clinics operating in Canada require women to go through a counselling session before deciding whether to freeze their eggs. But some may exaggerate their success rates or play down the severity of side effects, Taylor says. The websites of many clinics that offer egg freezing in Canada offer information about how a woman’s fertility declines with age and how egg freezing can extend those reproductive years. But few go into detail about the potential side effects or risks. It’s difficult to find much information on those sites about pregnancy success rates from frozen eggs, and how those rates change as a woman ages.
At Toronto’s LifeQuest Centre for Reproductive Medicine, Dr. Ken Cadesky argues that success rates may actually be much higher than the current literature states, but that we won’t know for several more years, until more women decide to thaw their eggs and try to get pregnant.
“The truth is that it is a realistic fear that at age 40 a woman may not be able to get pregnant strictly because of her age,” Cadesky said. “I don’t know if I’d say we’re tapping into their fears. I guess the idea is maybe we’re just providing a service because they’re so fearful.”
Part of the problem is a lack of standard guidelines in Canada. Even the Society for Obstetricians and Gynaecologists of Canada, which has policies on contentious issues such as sex-selective abortions, has no official position on egg freezing and how such services should be promoted. The Canadian Fertility and Andrology Society advises doctors to tell women about the risks of egg retrieval and pregnancy at advanced ages, but stops short of repeating the ASRM’s warning. It also doesn’t offer any specifics on age restrictions, or ways to mitigate the potential risks.
Health Canada hasn’t taken up the issue either. There are no rules on the types of marketing claims companies are allowed to make, no requirement for reporting botched surgeries or other serious safety problems and no guidelines on how freezing and pregnancy success rates can be reported.
Federal and provincial oversight of assisted reproductive services is largely non-existent. As a result, clinics are left to their own devices as to how they market egg freezing, who qualifies for services, what they charge and what they tell potential customers. Taylor believes the lack of oversight means “it’s only probably a matter of time” before serious problems emerge.
Rhonda Levy, founder and CEO of Empowered IVF (a consulting firm that helps men and women navigate assisted reproductive technology), is also worried. Since egg freezing is still relatively new, few clinics have a lot of experience, meaning that the choice of clinic could have a major effect on a woman’s chances of becoming pregnant, she explains.
“There are not very many clinics that have a significant track record,” Levy says. “It’s also very important for women who do it to realize it does not guarantee them a baby. It only provides the hope of a baby.”
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