Early this year, former Miss Universe and model-turned-actor Diana Hayden came close to being a poster girl for egg freezing in India when she spoke openly about having a baby through her eggs that she had preserved in an egg freezing clinic 10 years ago.“I was 32 when I first got to know about egg freezing,” says Diana Hayden. “The more I read up on it, the more excited I got with the idea that women could avail of such a wonderful facility that enables them to have a baby when they ‘choose’ to and not when they ‘have’ to. At 32, I hadn’t met my Mr Right and I didn’t want to marry someone just to make things more convenient for having a baby.
I also could not ignore the fact that the more I postponed motherhood, the fewer my chances of getting pregnant. After all, the number and quality of eggs that a woman’s body produces drops rapidly after 35, as she advances into her late 30s and 40s. So two years later, in 2007, I decided to freeze my eggs at Lilavati Hospital,
Mumbai, with fabulous medical support from Dr Nandini Palshetkar and Dr Hrishikesh Pai.” In retrospect, the decision turned out to be loaded with a healthy pinch of foresight—Diana was diagnosed with endometriosis in her late 30s, which made natural conception immensely difficult. The eggs she had preserved 10 years ago, though, gave her a choice to exercise an option to have her own biological child. At 41, she used those preserved eggs to deliver a healthy, beautiful daughter, Arya Renee Hayden, with husband Collin Dick, in January 2016.
THE NEW FERTILITY INSURANCE PLAN?
Diana spoke with disarming honesty on a topic that most Indians would typically choose to be tight-lipped about. But matters such as these are not as hush-hush anymore as one would imagine. Judging by insights offered by Dr Shweta Raje of Women’s Hospital, Mumbai, a growing number of young Indian women—both married and single—are now weighing egg freezing as an option to reproduce at a later date that is best suited for their career goals and financial status. “Ten years ago, egg freezing was not even something too many women knew about,” says Dr Raje, “But, today, there are at least a dozen single and married women approaching a women’s health clinic every week wanting to know more about this option. It is not a taboo subject anymore. Mostly, these are ambitious women in their early 30s, ranging from entrepreneurs to air hostesses to actors to bankers to teachers, who are not sure if and when they will get married in the near future. Of course, not all of them exercise the choice to freeze their eggs, but many consider the procedure as a worthy potential option. Also, as more and more women in India are facing fertility problems at a much younger age unlike earlier, there are times doctors insist on it in cases where fertility is severely impaired. For example, if one of the ovaries has been removed and we are not too sure about the performance of the other ovary, or if the woman has a borderline malignancy. It wouldn’t be fair to make them wait until marriage and let those eggs go to waste by then. Not that success rates are exactly phenomenal at present, but at least women have a greater autonomy over their bodies and a fair chance at motherhood in their later years.”
WHAT IS THE PROCESS LIKE?
So, what exactly does egg freezing involve? To start with, it is a progression of delicate steps that need keen scrutiny and patience. It takes about four to six weeks to complete an egg freezing cycle. Depending on your hormonal health profile, you will be administered hormone injections daily for two to four weeks to stimulate the ovaries to produce more eggs (so there are more options to choose from). Once the eggs are adequately matured, they are removed with a needle placed through the vagina (a procedure done under sedation). The eggs are then immediately frozen. When you are ready to attempt pregnancy—even if several years later—the eggs are thawed, injected with a single sperm to achieve fertilisation and transferred to your uterus.
According to Dr. Raje, if you are contemplating egg freezing, it is best to make a move before you hit 35. Any later than that, the quality of eggs starts getting poorer with each passing year. As Dr Nandini Palshetkar, who guided Diana Hayden through this novel procedure, says, “If someone chooses to freeze her eggs in her early 30s, and have a baby around 40, and she has had a successful implantation, the quality of her pregnancy won’t be greatly altered as the eggs that are implanted in the uterus are young. So, instead of waiting until 38 to freeze your eggs and have a baby in your 40s, I would advise young women to freeze their eggs in their early 30s even if they are planning on
a late pregnancy.”
As the process involves high-end scientific techniques and correspondingly expensive machinery to match, the charges are not exactly affordable to a vast majority. Depending on the clinic and the fertility specialist you choose, costs can be upwards of #2,oo,ooo to #3,00,000 with storage costs of #40,000 upwards for each year (Some clinics even offer free storage in the first year.) And what if you slip up on the storage fees? “There are strict legalities involved, but the hospital industry is based on the humanity quotient at the end of the day,” says Dr Raje. “So it is not as if the eggs are discarded if you don’t pay up in a particular year. But patients can discuss the payment terms with the hospital management and figure out the best options.”
Internationally, cash-rich companies have even included egg freezing in their human resource programme as part of the remuneration package. In 2014, Apple and Facebook offered to freeze eggs for their women employees in a bid to retain and attract more women. While Facebook announced a package of $20,000, Apple offers a series of staggered perks. Sounds exciting? Well, Dr Rosa Vincent, a Kochi-based gynaecologist, has her doubts about the seemingly generous benefits. “Your best fertile years coincide with the most productive and peak performance phase of your career. So, the age most mid-career women should begin to have children biologically—and normally—is also when they are faced with this choice when they can either advance in their careers or start a family. With so-called benefit packages like these, aren’t companies exploiting women’s talents at one level? Women who choose to go with the option of having a baby are put at a disadvantage when it comes to increments and promotions. How pro-women is this decision really?”
While it is always wonderful to hear of the success stories, one needs to be aware that the success rate of live births through cryopreservation of eggs is only up to 15 to 20 per cent. Also, egg retrieval may not always go exactly as planned, even if you are perfectly healthy. Neerja Gulati*, is among the small percentage of women who had a disappointing tryst with egg freezing in one cycle. The 36-year-old Delhi-based microbiology expert decided to go for egg freezing five years ago, when she got selected for a three-year international fellowship in a reputed San Diego university. “I invested a huge part of my savings in the procedure, but my doctor could not retrieve more than four eggs in one cycle which was well below the average number of eggs produced in a hormone-administered egg cycle,” says Neerja. “From what I know, doctors need to harvest an average of at least 15 to 20 eggs to work things out for a chance at future pregnancy. Also, not all eggs may be chromosomally sound.”There are many other factors that can deter the process and cause significant emotional and mental turmoil.
The dull success rate: In an interview to digital business publication Quartz, Dr Marcelle Cedars, director of the Center for Reproductive Health at the University of California, San Francisco, sounds a warning bell for women who think the process is a piece of cake. “There is a drop-off in success with every step of the baby-making process. After the eggs survive thawing and implantation, the embryo has to survive early cell division, which pegs the final pregnancy rate per egg around 10 per cent.” Even if you do freeze your eggs before you hit your early 30s, defrosting them in your late 30s or 40s can only mean pregnancy in an advanced maternal age. While the eggs will be of good quality, you have to be prepared for all the possible risks associated with late pregnancies: miscarriage, gestational diabetes, preeclampsia and pre-term birth. Therefore, ensure that you are at your fittest best if you are planning to have a late pregnancy to avert these issues.
Ovarian Hyper Stimulation Syndrome (OHSS): Normally, a woman’s body produces one egg per month. When the hormones administered to prompt the ovaries to produce more eggs ends up stimulating it excessively, the ovaries can become swollen and, in complicated situations, fluid can leak into the belly and chest area. The typical symptoms of OHSS can range from abdominal bloating to significant weight gain. OHSS occurs only after the eggs are released from the ovary. Also, women suffering from polycystic ovarian syndrome are more likely to suffer from OHSS. “If the hormone levels are being spiked excessively, we take a call to cancel the cycle, as it can even be a threat to the patient’s life if you allow the cycle to go ahead,” says Dr Raje.
All things considered, egg freezing is an empowering solution in the long run for women who are distressed at the thought of compromising on a career that they have worked so hard to build and who are also sure they want to enjoy motherhood. At the same time, it also pays to heed the warnings pouring in from international bodies such as the American Society for Reproductive Medicine, which has been cautioning women against choosing this as a true and tested method to delay childbearing. Think through carefully before you make your choice. After all, like every choice you make, this is the one you have got to live with.