Saturday, November 18, 2017

Egg freezing - how old is too old ? The limits of IVF technology

While the Times of India article about a celebrity carrying a twin pregnancy after egg freezing will help increase awareness about the option of social egg freezing as a method for preserving fertility in older women, I am very concerned about the misleading message this is going to  send to most  women!
They are going to start believing that IVF specialists are magicians  who can get anyone pregnant - and that a woman's biological age does not affect her fertility. Women will delude themselves that they can happily postpone having a baby for as long as they like , but this is false ! There is a price you pay when you try to have your cake and eat it as well, and the bitter truth is going to create a lot of unhappiness when they find out the truth.  When have a biological clock, and while egg freezing is a sensible option for women in their 30s, to try to offer it to women in their 40s is foolhardy.
This particular story itself is a little hard to swallow. The success rate of freezing eggs at the age of 41 is exceptionally low  - and then to get pregnant with twins with these frozen eggs requires one to suspend their credulity. Human reproduction is not efficient, and there is a lot of wastage and attrition even during IVF. Yes, we can make a 40 year old grow follicles, but many of these will not contain eggs; many of these eggs will not fertilise; and very few will form good quality blastocysts which are worth transferring.
Yes, we can get older women pregnant easily, but they have to be willing to use donor eggs , and this is not an easy decision. Of course, clever older women who use donor eggs to get pregnant can now claim that they got pregnant with their own eggs which they had frozen when they were younger - and no one's going to challenge them !
The facts are that the ovarian reserve for a woman drops off dramatically after the age of 38, and the pregnancy rate with IVF even with fresh eggs after the age of 40 is less than 5% per cycle. The live birth rate is even lower, because embryos from older eggs  have a much higher rate of  genetic anomalies !
The right age to freeze eggs is less than 35, because it gives women a good chance  of having a baby. Most IVF clinics will agree that doing this after the age of 40 is futile.
On second thoughts, maybe I shouldn't complain about this misleading article , because all IVF clinics will now get lots more  referrals from older women who want us to freeze their eggs, but giving patients false hope is hardly the right way to practise medicine !

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