Wednesday, July 17, 2013

Should I freeze my eggs ?

I just completed a consultation with a single 38-year-old banker who wanted to freeze her eggs. She said, " Doctor , I have still not been able to find the right guy to marry , and I am not getting any younger . If at some point I do want to have babies, I want to freeze my eggs now so that I don't have to worry about the increased risk of birth defects or reduced fertility as I get older ".

I explained to her that we could freeze her eggs, but my concern was that she may have already missed the boat ! The right time to freeze eggs is when they are of good quality, and there are lots of them. From a biological perspective, this should be done when a woman is young - preferably at the age of 25 !

I understand it's unrealistic to expect 25 year old women to freeze their eggs . When you are young, and you have your whole life ahead of you, the probability of being able to find the right person , and then settling down and have a baby in the bedroom is extremely high ! However, if you postpone this decision until you cross 35 , even though egg freezing still remains a viable option , the reality is that the success rate of having a baby with these frozen eggs does drops dramatically if the freezing is done after the age of 38.

This is because ovarian reserve declines with age,  and while the decline varies from patient to patient, it does mean that the success rate with egg freezing goes down . So what advice should a specialist give to a woman who wants to consider freezing her eggs ?

In the best of all possible worlds , the best time to freeze eggs is when you don't need to - when you're young and have lots of them ! However, in real life , there are very few women who will consider an option which is expensive - and one which they may end up not using at all.

The trouble is that when women are good candidates for egg freezing -  between the ages of 30 to 35 , they have so much going on in their life , and rightfully feel that their chances of finding the right person and getting married are so high , that they still not willing to consider the possibility that they may have difficulty having a baby in the bedroom when they want one. The biological clock is still quite muffled at this stage in a woman's life ! This is why it's usually when they start crossing 37 that they start exploring all these additional options . They may have heard stories from their friends, who needed to do IVF to have a baby. This is wake-up call for them, and they are prodded into exploring their reproductive desires much more closely. While we are happy to do egg freezing for any woman, no matter what her age ( after all, he cannot become younger, and it's better to do it late than never !) , the reality is that they may not have such a great success rate , and it would have been much better for them to have done it earlier, rather than to have postponed making this decision for so long.

So should I freeze her eggs or not ? This is always a hard decision to make - especially for something which is elective treatment , and which can be quite expensive ! This is a decision which the patient has to make, and I am the kind of doctor who is very reluctant to tell patients what to do, I feel my job is to be a counselor , and allow them to come to their own decisions.

I help them to consider the pros and cons of both paths, and they suggest they take the path of least regret, so that they have no regrets afterwards.

This was my explanation. Suppose we do freeze your eggs , and then you find Mr Right the next month and then have a baby in your own bedroom - how much will you resent the fact that you spent your money on freezing your eggs and never used these frozen eggs ? On the other hand, suppose we don't freeze your eggs , and then you decide you want have a baby at the age of 42 , and learn at that time that you can't because your eggs have become too old. How much will you regret not having  frozen your eggs when you were 38 ? These are very personal answers - and they will vary from person to person ! The best thing to do is to choose whichever path causes you the least regret ! These are obviously very individual decisions , which are not to be taken lightly , and it involves using both your head as well as your heart .

It's very easy for a doctor to say - This woman has come to me for egg freezing , so I am going to go ahead and do it for her - and from a doctor's perspective , it makes a lot of sense to do so, because doctors get paid for performing procedures ! From a financial point of view , it makes no sense for a doctor to say no to a patient who wants egg freezing. However, patients need to have realistic expectations of what we can do with these frozen eggs, which is why doctors need to counsel them and arm with them all the facts.

The woman came back after 3 days and said - " I know I am 38 and my eggs are old, but I am not getting any younger , and if I freeze my eggs , even if I do find someone and have a baby in my bedroom, these eggs will always be available to me as a backup option . In any case, even if I end up not using my frozen eggs. I won't feel bad about it. " I was happy to hear this, because it's crystal clear that she's thought through things logically and analytically , and then come to a decision which she is comfortable with.

Patients need to remember that egg freezing offers hope -  not a guarantee. If patients have unrealistic expectations of medical treatment , they are likely to be unhappy with the doctor , and unhappy patients make for unhappy doctors.

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