Episode 74: Let’s Talk About Fertility and Egg Freezing

In this episode, Dr Bahijja Raimi-Abraham talks about single women’s fertility and egg freezing with Dr Zeynep Gurtin, a Lecturer in Women’s Health at the Institute for Women’s Health at University College London (UCL), and holds an Affiliate Lectureship at the University of Cambridge Sociology Department.

Image of fruits and seashells arranged like an ovum and sperm by Dainis Graveris.

Dr Bahijja: Tell us a little about yourself?

Dr Zeynep: Sure, my name is Dr Zeynep Gurtin and I am a lecturer in women’s health at UCL, and I am a reproductive sociologist. Many people have likely not heard of that field before, but essentially I am a sociologist that specialises in issues around fertility and reproduction.

Dr Bahijja: What is your favourite song at the moment?

Dr Zeynep: I’m terrible with music and don’t keep up to date, but today while walking my dog I was listening to “Gracias a la vida” and its such a lovely song!

Dr Bahijja: Can you recommend a film and/or a book?

Dr Zeynep: In terms of books, I just read a great book called “How to be a good creature” — the author writes many books on animals. She goes through 13 animals and goes through lessons they taught her — I highly recommend it!

Dr Bahijja: Please tell us a little bit more about your research?

Dr Zeynep: Yeah, so at the moment we are living in a really interesting time. There are huge shifts and changes in how people create their families. My work really focuses on that subject — like the feelings and subjects specifically regarding high tech reproduction. This would include IVF, sperm-donation, egg freezing and similar reproductive technologies that people use for a multitude of different reasons. I explore the experiences of people using these technologies in a really qualitative way. More recently, I have done research into the experiences of women going through late motherhood (such as 40+).

Dr Bahijja: What is Women’s Health and why did you decide to focus your work in this area?

Dr Zeynep: I’m not entirely sure, to be honest [why I decided to work in this area]. This is quite a new area of focus, but for me I think I just kind of fell into it. My first research project was on couples going through IVF and their ex, such as with gender identity, mental health and more. I also think this subject is really not as visible as it aught to be currently, even in the communities where it is less taboo to discuss. […]

Dr Bahijja: What is a patchwork family?

Dr Zeynep: That term is sometimes used to denote families with adults in a household for whom it may be a second, third or further marriage or union, or children from different parents or marriages.

Dr Bahijja: How has reproduction and the view of reproduction changed over the last decade?

Dr Zeynep: It has changed massively! Women of our generation face a completely different set of options and reproductive choices. Even just compared to our mother’s, there are massive changes. For example, age of first motherhood has been increasing — in the UK it is now over 30. Fertility rates are also falling, birth rates in the UK are the lowest they have ever been. They average family size is also 1.89, which is lower than previous. This isn’t just in the UK too, this is in many countries. Women are overall having fewer children (or none) and having them at older ages. More children are also born out of wedlock or via single mothers and more women over age 40 are having children then ever before (it has tripled). Unfortunately, some of the more difficult issues we are seeing due to women having children at older ages include involuntary infertility and age related fertility decline. For example, by 45, 1 in 5 women will be childless and at least a portion of that statistic is due to infertility. […]

Image of contraceptives by Reproductive Health Supplies Coalition.

Single Women’s Fertility

Dr Bahijja: Why is this (Single Women’s Fertility) an area that requires attention?

Dr Zeynep: With all of these changes in society, more and more women are entering parenthood at single mother’s, oftentimes with donor sperm (formally or informally donated). We have also seen an increase in co-parenting, where a mother or parent will raise their child/children with someone they are not romantically involved with. It is really interesting as we can see the changing nature of relationships in families in the current day. Women often tell me they pursue solo mothership due to that question of and that changing idea of relationships and parenthood. For example, they feel they don’t have to time to find the right partner, they may want more agency and control over their reproduction, or they may want to separate parenthood from romantic or sexual relationships. Sometimes they are waiting for the right partner in the future, and sometimes they just want to be a single parent. […]

Dr Bahijja: What are the options for single women who would like to have children but don’t currently have a partner?

Dr Zeynep: So, there are a couple of options. One popular option is called DI (donor insemination), which when a sample of donor sperm is inserted into the uterus at the right time of the month to allow for conception. This is a good option for those without any infertility issues.

IVF is also possible for donor sperm — IVF is a more involved and invasive process involving drugs, egg collection, fertilisation (within a lab) and then placement of the egg back into the individual. Some people also opt to find a sperm donor through an informal process (such as via online forums), however, there are certain legal protections and benefits that in a clinical setting that are not present in these informal donations. Oftentimes, this route is taken due to issues of cost.

Egg freezing is another popular option, especially for those who are concerned about potential fertility in the future but are not ready or sure they would like children in the current moment.

Dr Bahijja: Could you talk a little more about egg freezing?

Dr Zeynep: So egg freezing its quite a new technology, in the [EU it only really received the go-ahead in 2012] to be used in an elective manner. Beforehand there was some egg freezing, but only allowed in instances where it was determined to be needed, such as with people going through chemotherapy who had concerns about having children afterwards. Eggs are now frozen using a technique called vitrification, which involves a complex process that increases likelihood of survival. It is far more complex than freezing sperm, as ovum are far larger in size and are more complicated cells. We know from EU national statistics, nowadays, that egg freezing is the quickest growing fertility treatment — but it doesn’t account for a huge number of people per year.

The process is similar to IVF — the patient would go through several weeks of hormone injections to encourage multiple eggs to be released. There is then a surgical procedure to remove the eggs, and the eggs are then frozen via vitrification. If the eggs are used in the future, they are then thawed, fertilised and then implanted in the uterus. So, its similar to IVF but delayed and using frozen eggs. […]

Dr Bahijja: I understand that there is currently a 10 year limit on frozen eggs, but there have been discussions on extending this period. Could you expand a bit on this?

Dr Zeynep: That 10 year storage limit in the UK is an important consideration for fertility planning. If you are 30 when you freeze your eggs, and maybe you don’t want a child until after 40, [then the process is a bit wasteful as maybe you will only want a child at 45+]. In terms of the technology, there is not a particular reason they are stored for 10 instead of 15, 20, etc. Once they are vitrified they do not degrade. It’s arbitrary, which is why many women have been campaigning to extend this limit. There is not really a reasonable justification for this limit, and its heartbreaking to have to throw out the eggs after 10 years if you have not used them. […]

Image of frozen ice by Aaron Burden.

Dr Bahijja: You have spoken in the past about misleading advertisements from egg freezing clinics. Could you give some examples of this? What can be done to prevent private clinics from taking advantage of women who are interested in freezing their eggs?

Dr Zeynep: The short answer is that egg freezing is not really regulated. It is the only fertility treatment in the UK that is exclusively private — this of course does not include medical egg freezing (such as for chemotherapy patients), which is covered by the NHS. If you are a women concerned about her age, relationships, etc. and you want to freeze your eggs electively (non-medically) for later in life, you can only do this privately. Most women just then search “egg-freezing London”, “egg freezing UK”, and most of the hits on google are fertility clinics.

Did you know? IVF has a success rate of about 25–30%. This is why many people will have to go through multiple cycles of IVF in order to have a successful pregnancy.

Looking at a lot of marketing, however, a lot of the information was misleading or left out important decision making factors. Oftentimes, only the benefits were discussed and not the potential downsides and risks (whether the risks be from the hormone medications, the surgery, etc.). Also, we found many of the websites give a misleading impression on how successful egg-freezing is. The actual success rate is about 1/5, so for every women who becomes pregnant from frozen eggs, 4 will not. When making decisions about invasive medical procedures, that are expensive, you should be aware of these facts and figures. I highly recommend to check the EU Human Fertilisation and Embryology website for accurate and non-biased information on the subject. […]

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