To Freeze or Not to Freeze?

An interesting question was raised recently - Should a woman in her late 30s with no partner store her eggs as insurance against declining fertility in the future?

The situation is quite clear - eggs stored before the age of 40 are much more likely to result in successful pregnancies than eggs harvested fresh a few years later so if you turn out to have difficulty conceiving later in life then a few eggs ready to use will increase the chances of a successful pregnancy and reduce the risk of some genetic disorders in any children.

What is interesting here is the amount of consideration required by what seems on the face of it to be a simple decision based only on whether or not there is enough money available to pay for the procedure and whether or not it is safe to have done.

Firstly of course, there are risks in this or any other medical procedure. In the case of egg harvest the risks are higher than many common medical procedures but lower than other risks you might willingly undertake, such as driving. In the case of egg harvest, the main risk is ovarian hyperstimulation which though common at about 5% per cycle is rarely life or fertility threatening. Egg Donor America gives a useful disclosure of what might be involved.

If eggs are frozen then the following scenarios will need consideration:

Never meeting a suitable partner.
A partner who is perfect apart from not wanting children.
A partner who is infertile or unwilling to consider artificial methods of reproduction.
A partner who already has other children.
Conceiving naturally.
What age is too old?
When to tell the partner?
What if there is only one child? What if there are three? What if there are none?
What to do with any left-over eggs or embryos.

Perhaps the easiest decision occurs when conception occurs naturally. For healthy women, about 36% aged 40 will conceive within a year but this drops to 5% at age 45. In this case the biological imperative to reproduce has been satisfied, though there may be a desire to keep eggs to increase the chances of a sibling.

If a partner does not wish more (or any) children, then the issue is somewhat thornier as he would have to consent to assist with fertility and using the eggs would be difficult or impossible. Of course, having stored the eggs, a partner willing to consider using them would be preferred. This probably means that the sensitive issue of procreation will have to be raised much earlier in a relationship than is the norm, before both partners are fully emotionally invested - potentially a make-or-break moment for any couple.
Even if a partner keen to reproduce is found, will he see the egg storage as sensible foresight or cold and premeditated? Should he be told at the outset, before he is committed, or after when witholding such disclosure might be seen as a breach of trust?

Where a partner has other children, additional issues arise. Babies born through IVF require considerably more effort from both partners and there is always a lot more concern during pregnancy and in the neonatal time, no matter how hard parents try to be normal. This is understandable, but it does place a slightly different dynamic on a family and the effects on any children will certainly be something a potential partner should consider.

As people become more career-focussed, we are seeing more couples having their first child when both are in their late 30s or early 40s. This is not the place for an in-depth discussion of the issues of being an older parent itself, but it is important to recognise that being a parent gets harder with increasing age. The physical demands of sleepless nights, caring for a toddler and keeping up with a pre-teen are not insignificant. Similarly, changes in financial opportunities (being older is not necessarily worse here) must be considered, even if it is not the be all and end all.
Children can be the focus of a lot of social interaction and many friendships are made amongst parents. This is harder if you are much older (or younger) than the other parents around you. Older parents do get assumed to be grandparents from time to time. You need to be prepared to cope with other people's assumptions and prejudices, however ill-founded they may be, and not to fit in with those you might normally consider to be your peers.
Whatever you believe know only that it is MUCH harder than you think it is - even if you think it is going to be tough, it is harder than that. If you do not believe this, you have not understood the issues fully and really need to think again.

IVF leads to an increased risk of twins or triplets. Though a multiple birth means a much more stressful pregnancy and a lot more work in infancy, an only-child is very hard work for many years as the lack of siblings leads to a lack of playmates. One parent once said "I didn't know I'd have to be a four-year-old all the time!" which pretty much sums up the problems of the single child family - it is not always possible to find a spare child elsewhere to share the load!

Of course if Mr Right never appears then there is still the question of donor insemination and rearing a child alone - this is of course common and there is a lot of support even though it is harder to go it alone, but it may make it harder to find a partner in the future.

After the age of 40, success rates from IVF drop rapidly and by the age of 45 the chances are not good. This has not improved in recent years and it seems quite likely that there will always be a much lower success rate than desirable for older mothers. There are a few cases of women conceiving by IVF long after menopause, though the risks are high and the probability of success is low. Even if good eggs are stored, there is a fairly high risk that they will not implant anyway and this increases with age. Is a low chance better than no chance? Could you bear going through four or five attempts to implant an embryo and come away with nothing in the end? Similarly, miscarriage rates are high in IVF - could you bear that? What if it was your last egg?

Where eggs or embryos remain, there is the final decision to make. If you have been lucky and had children, would you give them to another couple, to research or have them disposed of? What if you decided not to use the eggs after all - there will have to be a day when they are gone for good.

This is a medical thought piece and is intended to be used to stimulate debate and to inform. Whilst every effort has been made to use accurate figures as of the date of publication (May 2015) it is to be considered opinion and not generally accepted medical fact. Thought pieces may be updated from time to time and comment from readers, especially that suggesting improvement is always appreciated.

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