Eleven years ago, a gynaecologist told me my fallopian tubes were “obliterated”. He had just performed adhesiolysis, the surgical removal of scar tissue. In my case, the scarring was from a ruptured appendix in my youth, and, as has subsequently been discovered, endometriosis. As I wouldn’t be able to conceive naturally, the doctor asked me whether I would like to do free egg or embryo freezing with the NHS. Having always known I’d want a baby some day, the answer was yes.
The doctor told me that the chances of a future pregnancy would be higher if I froze fertilised embryos, rather than my eggs alone. I am gay, not around sperm much, and always preferred the idea of using a donor to conceive rather than doing it with a male friend. So I selected a donor from a US sperm bank and had it shipped over before my freezing cycle began. After a fortnight-long hormonal drug cocktail, my eggs were “harvested”. The viable ones were fertilised and produced some good embryos. They have been in a hospital freezer for 10 years; a comforting thought, but also one so abstract I can barely entertain its implications.
Under current UK legislation, my embryos can stay on ice for 55 years because the treatment was the result of a medical problem. If they had been frozen instead for “social” reasons – because I had not met someone I wanted to have children with yet or didn’t think I could afford a baby – I would have had a maximum of 10 years in which to use them. It is punishing to think that, if things were different, they could have been destroyed this year simply because I don’t feel ready to have a child.
Fertility experts have long been lobbying against the 10-year limit on freezing eggs, embryos and sperm. The rule, set out by The Human Fertilisation and Embryology Act in 1990, is arbitrary; eggs and embryos can be safely freezed indefinitely. The UK government finally seems to be listening and announced this week that the 10-year rule would be scrapped. In future, everyone will be able to freeze genetic material for up to 55 years, regardless of their reasons for doing so.
There has been a rapid growth in egg freezing in the past 10 years, from just under 230 cycles in 2009 to 2,400 cycles in 2019. The process involves 10-12 days of self-administering injections containing hormonal medication that stimulates egg production in the ovary follicles, with regular clinic visits for scans and blood tests to monitor progress. Following this, under sedation or general anaesthetic, a process called transvaginal oocyte retrieval happens, where a doctor inserts a needle through the vaginal wall and into the follicles to retrieve the eggs. Let me tell you: you can feel that this has happened.
Egg freezing was once reserved for medical reasons, such as preserving fertility that might be affected by chemotherapy. It has since been rebranded as a way for women to gain some control over their fertility clocks; to own our future. The egg-freezing industry is worth millions in the US, where private equity firms target twentysomething women with the idea that freezing eggs at 25 is a smart career move.
Here in the UK, the Human Fertilisation and Embryology Authority (HFEA) inspects fertility clinics against a code of practice, which states that they should not highlight high success rates that only apply to small, selected groups of patients. But thousands of women every year continue to absorb the idea that we can buy time, paying a small fortune for hope.
The average cost of egg freezing is about £3,350, not including the hormonal medication required, which can cost thousands. There is a postcode lottery for what NHS fertility clinics can offer people – some will offer elective egg freezing and storage, if you pay for it – and many turn to the private sector. The cost of storing eggs can be up to £350 a year. Prices like these should come with guarantees, but that is impossible.
The reality is that not every egg makes an embryo; not every embryo results in pregnancy; and not every pregnancy results in a baby being born. Data from the HFEA shows that once-frozen eggs account for only 1-2% of all IVF treatment cycles. Age is a crucial factor: eggs are of a much higher quality in our 20s and, if they are frozen below the age of 35, the chances of success will be higher than the natural conception rate as the woman gets older. This makes scrapping the 10-year storage limit even more necessary – if women need to freeze their eggs earlier for a better chance of getting pregnant, they need more time in which to access them later on.
If the new 55-year storage limit does encourage more people to freeze their eggs, clinics have a responsibility to convey the reality of the process. Framing fertility treatment as something you can just pop into a clinic for is misleading: manufacturing then surgically retrieving eggs from your body can be challenging. The hormonal medication can make you feel bloated, queasy and anxious, while the egg collection can cause a lot of pain, with possible complications. (I had a bad time of it, but not everyone does.)
Being able to use technology such as egg freezing and not feel so pressured by our fertility clocks is a benefit of living in the modern world. But the modern world is also what is driving this booming market, particularly for young people – the ones who stand the highest chance of preserving their fertility, should they wish. Living is more expensive than it ever was. That the process will be unaffordable to so many adds another layer of unfairness.
The prospect of more room to make important decisions about having children is great, but we must remain realistic about what egg and embryo freezing actually entails, how accessible it is and the inherent lack of certainty. After all, many people of childbearing age feel the choice of having a family has been taken away from them, not by the inaccessibility of fertility treatment, but by a complete lack of economic security in life. (Britain’s birthrate is plummeting; in the US, the birthrate is the lowest it has been in 35 years.)
Better wages, access to stable housing, affordable childcare: fundamental social changes like these are required to temper the crushing uncertainty so many of us feel about having babies at all. Having the option to store eggs for longer is good, but it is not the panacea we are often led to believe it is.