One month before her 41st birthday, Ilana heard about the new law passed in Israel in 2011, regulating oocyte cryopreservation – egg freezing - for women aged 30-41. “I didn’t think – I just went to the doctor to start the process,” said the American-born, Israel-raised lawyer. Two weeks later, her doctor retrieved 30 oocytes and froze them, to store for possible use in a future in vitro fertilization procedure.
Ilana was lucky. She produced more eggs in one cycle than many women her age do in four. With certain constraints, women may undergo up to four retrievals or until 20 eggs are obtained (whichever occurs earlier), according to the October 2011 Ovum Preserving Law. The state doesn't pay for the procedures involving egg freezing but it does regulate the process. (Eggs are frozen for fertilization outside the body; they cannot be thawed and reinserted into the womb.)
Oocyte cryopreservation is not new. In the past, it didn't work well and pregnancy rate from frozen eggs that underwent fertilization after thawing were low. In recent years however freezing technology has vastly improved. Today 95% of frozen eggs survive the freezing process, making it nearly equivalent to using fresh eggs for in vitro fertilization. In the U.S., about 2,000 babies have been born from frozen eggs.
And as women take longer to marry– in Israel, according to the Central Bureau of Statistics, single women aged 25-29 rose from 13% in the 1970s to 46% in 2013 – more Israeli women are freezing their eggs for future use.
Aging as a fertility disease
“For women, aging is a disease from the point of view of fertility,” says Professor Doctor Talia Geva, Director of the Reproductive Endocrinology and Genetics Unit at Shaare Zedek Medical Center in Jerusalem. “We are treating disease: if we can help prevent a disease, we should do it with preventative medicine."
In the freezing process, a woman takes hormones to increase her egg production. Then prior to ovulation, with the patient under sedation, doctors extract the eggs (“retrieval”). Unlike in IVF, where eggs are then fertilized with sperm and after a few days transferred to a woman’s uterus - with freezing, the eggs are stored for future use.
“Freezing eggs is a form of health insurance – it enables you to freeze your biological age at the age you are currently at,” said Dr. Itai Bar-Hava, the Medical Director of the A to Z Fertility Center in Tel Aviv. For example, a 42-year-old woman who froze her eggs at age 35 has the same chances in IVF as a 35 year old. “I think it’s the biggest feminist revolution since the invention of the pill: It gives women power over when they have kids, and if they feel they are currently not ready, they can take the time to build their life in other ways,” he says.
The woman's body doesn't get frozen in time, though. Even with eggs frozen well in advance, pregnancy outcomes from IVF decline in recipients over age 44, according to the Society for Assisted Reproductive Technology (the study was done on IVF using fresh oocytes, not frozen ones, but its findings still apply). From age 45, doctors report statistically significantly lower rates of implantation, clinical pregnancy, and live birth, and from age 50, the stats dip lower still.
Meirav decided to freeze her eggs three years ago, when she was 37. “After I did, I had a certain feeling of relief, that I did something that empowered me,” she said. But she found the process daunting. “It was a challenging experience, injecting yourself with three types of hormones at 1 in the morning, alone. It brought on a lot of anxiety,” she said, noting that she had to ask her parents for the 20,000 shekels ($5,250) for the cycle. She only had 7 eggs to freeze – far below what doctors recommend – but wouldn’t go through another cycle to retrieve more. “I didn’t feel like I could do it again,” she said. “Do I really think it’s an insurance policy? It’s a very small reassurance.”
And that’s what many people don’t realize: egg cryopreservation can feel isolating, be expensive and is not guaranteed to produce a child.
In healthy women, the average chance of achieving a pregnancy per egg is about 10 to 12 percent, say experts. So freezing between 10 to 12 eggs (by a certain age) gives a good probability, say the experts – but not a certainty – that pregnancy can be achieved, at least until age 45. After that, as said, the chances decrease.
Women can consult online fertility calculators to predict the probability of pregnancy, entering in the age at which she froze her eggs and how many she froze. (For example, with seven eggs frozen at age 37, Meirav's chance of a baby was 16.7%).
Some women want to increase their chances, so they freeze more eggs. When she was 36, Sarah Elizabeth Richards, author of “Motherhood Rescheduled: The New Frontier of Egg Freezing and the Women Who Tried it” spent two years freezing a whopping 70 eggs. Now, 42, she has a serious boyfriend—something she feels she was able to achieve knowing she’d frozen her fertility. “It was great. You’re more relaxed and you feel so much better about yourself -- you feel like you’re taking charge of your life, and that you’re taking care of yourself," Richards says.
But she encourages women to do it when they’re younger, not as a “rescue” plan. Fertility begins to seriously decline at age 35, with a steep drop-off at 40. “If you are 33 and you don’t have a boyfriend and you want a couple of kids, why not freeze them?” She also encouraged young mothers who weren’t ready for their second or third child to consider freezing their eggs.
Don't fall for the high-tech hype
The process requires women to take their own "ticking clock" seriously, and in fact, many people overestimate the fertility of older women. According to a 2011 study published in the journal Human Reproduction, “The fertility myth: Israeli students’ knowledge regarding age-related fertility decline and late pregnancies in an era of assisted reproduction technology,” professors at the Academic College of Tel-Aviv Yafo surveying more than 400 undergraduate students at different universities, and found that they overestimated a woman’s chance of getting pregnant naturally and through IVF.
“Only 11% of the students knew that genetic motherhood is unlikely to be achieved from the mid-40s onward, unless using oocytes frozen in advance,” the study found. These “entrenched fertility myths,” the authors found, can be explained by technological “hype and favorable media coverage of very late pregnancies.”
Some worry that this “hype” about egg freezing and IVF has misled people into believing that women can have children at any age. In another study “Egg freezing for age-related fertility decline: preventive medicine or a further medicalization of reproduction? Analyzing the new Israeli policy,” found that the technology’s risks are downplayed by the Israel National Bioethics Committee and “this may culminate in raising false hopes about women’s possible late genetic motherhood leading to involuntary future childlessness.”
So the question remains: should women freeze their eggs?
“Now we’re moving from medicine to sociology,” says Dr. Geva. “Since I’m a doctor, I believe in the human right to decide for themselves.” That being said, she added that she doesn’t think most women will do it because of the expense and, as she puts, it, “it’s not a cup of tea.” She would advise a 39-year-old woman to get pregnant instead of freezing her eggs. But, “If they can’t decide if they want to have a baby, then freezing your eggs is better than nothing.”
This is Part 2 of Fertile Ground, Haaretz's series on IVF in Israel. For the rest of the project, click here.