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    1. Health-fitness

    Should You Freeze Your Eggs?

    Trying to beat her biological clock, Sarah Elizabeth Richards turns to extreme science.

    By Sarah Elizabeth Richards
    Published 17 March 2008 In News

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    "You've got to think about these things!" my mother pleaded. The problem was that I couldn't stop, and over the past year, the chatter in my head had become unbearable. "These things" were the fact that I was 36, did not have children, and had no immediate plans to produce them. And I was exasperated and exhausted with the message that if I didn't hurry up and get knocked up, I was going to be Very, Very Sorry. The worst part was that I was starting to believe it.

    I was pretty sure I wanted kids. I just didn't want them right now. For about a year, I'd been dating a great guy who showered me with affection and stocked my favorite wine, but he was in no rush to have kids either. I wanted more time to discover who we were as a couple — to fantasize about trips to Thailand and Armenia, work from Miami in February, linger at dinner, and loaf on Sundays. I'd spent years looking for him, and I didn't want to share him with anyone yet.

    I knew it would be gratifying to make and raise little beings that had his Cheshire-cat smile, but I didn't feel that soul-strangling emptiness that made my girlfriends lose it while gazing into the windows of Tartine et Chocolat. I'd worked hard to create a life full of kooky friends, volunteer committees, softball games, and tasting menus. As Johnson & Johnson reminds us, "Having a baby changes everything." Well, I liked "everything" the way it was. I didn't need a baby to complete me.

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    But there was The Biological Clock — a worn metaphor but spot-on accurate, because sometimes it ticks so loudly it makes us stay up all night feverishly Googling "fertility options." We panic that somehow we are going to miss what we didn't even know we were missing: the chance to photograph fat-cheeked toddlers in floppy sun hats on the beach, watch them smear birthday cake all over a high chair, or nauseate strangers with clapping songs. We used to have decades. Now, we're down to a few years. Without even realizing it, we have become Clock Tickers. I have seen this pressure push people into lackluster marriages or fret their lovely, confident selves into frenzied, fearful heaps. The Clock is freaking the bejesus out of us. That is why I found myself sitting in an overly air-conditioned conference room in a New York City office building on a Wednesday night with about 30 pretty, well-dressed women of a certain age to hear a presentation about egg freezing. No one, including me, was chatty. Dr. Alan Copperman, director of infertility at Mount Sinai Medical Center, droned on about what we already knew: The quality of a woman's eggs significantly declines after 35, plummets after 40, and is generally toast by 45. He traced the familiar downward slope on a graph, then pointed to an intersecting flat line. That was the uterus, which apparently functions the same if we are 25 or 65. Imagine, he challenged us, being able to stop our eggs from maturing through a revolutionary new freezing process. We could have them thawed, fertilized, and implanted in our own ageless uteruses — whenever we wanted!

    Hands flew up. We pressed him for answers: Did it work? How much did it cost?

    We learned that Copperman was representing Extend Fertility, an egg-freezing company that is partnered with seven fertility treatment clinics nationwide. To do it, he explained, you stimulate your ovaries to crank out about a dozen eggs by injecting yourself with hormones for 10 days or so. After a 10-minute surgery to retrieve them, the eggs are dehydrated, filled with an "antifreeze" (to prevent ice crystals), slowly frozen to minus 196 degrees Celsius, and transported to a liquid nitrogen tank outside Boston. But empowerment doesn't come cheap: The whole shebang costs anywhere from $13,000 to $17,000, plus an annual storage fee of $450.

    I remembered reading about egg freezing when Extend Fertility opened in the summer of 2004. Back then, a handful of fertility clinics cautiously offered the procedure to cancer patients worried that chemotherapy would damage their eggs. But Extend was one of the first to unabashedly market "elective fertility preservation" to Clock Tickers. (The website trumpets "Fertility. Freedom. Finally.") It's not clear how many of the country's 400 or so fertility clinics have expanded their clientele, but it's clear that a number of them are tapping into this new market. Founder Christy Jones, who froze her own eggs two years ago at age 34, said that about 60 percent of the 200 women across the country who had frozen with Extend had done it for age-related reasons. So far, no one had come back to use them.

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    I also remembered that early success rates were depressing: A woman had less than a 20 percent chance per in vitro fertilization (IVF) cycle of getting pregnant using a frozen egg — and that was if it survived the freezing and thawing process in the first place.

    Now, a few years later, Copperman delivered the big bang we were all waiting for. Thanks to the refinement and export of a slow-freezing process by Italian scientists, results had improved dramatically. He announced that five of six women had successfully become pregnant using their eggs frozen at his clinic — RMA of New York — and IVF New Jersey; so far, seven healthy babies (including two sets of twins) had been born. That seemed even more miraculous when you looked at how many eggs it takes to make just a few embryos: For the two women from the New Jersey clinic, a total of 48 eggs were frozen; 38 survived freezing and thawing (85 percent), 33 were fertilized, and five of the 12 embryos were successfully implanted.

    I knew these samples were small, but I felt relief wash over me, and I wanted to shout at these strangers: "Did you hear that? It's all going to be OK." On the way home, my eyes started to water. For once, it didn't matter that I'd frittered away my 20s with a man I loved but did not want to marry. Science would save me.

    It didn't take long before the anxiety resurfaced. I knew I was the target of an aggressive campaign — one that put out promotions like "Freeze with a friend" and encouraged women under 35 to have the procedure because that's when their eggs would be in their prime (and they could start racking up storage fees).

    On a tip from a friend, I called Dr. Nicole Noyes, one of the doctors who started the egg-freezing program at the New York University Fertility Center and who has banked the eggs of more than 50 women. I wanted to know if success rates really had improved. They had, she said. Her study bore eight births from 15 cycles of IVF with frozen eggs. I gasped. Those were roughly the same success rates as IVF with fresh eggs! "When should women do it?" I asked. Her answer: At the last minute possible. Since technology would likely continue to improve, women under 35 should wait. "I say to them, 'Hold out and see what your life brings.'" As for me, Noyes said that if I didn't foresee having a baby right away, I should decide to freeze as soon as possible.

    Something about my enthusiasm seemed to annoy Noyes — as though I wanted to freeze just so I could fit in a few more South Beach getaways. "Don't just think, 'Freezing bought me six free years,'" she warned. If I decided to thaw my 36-year-old eggs at age 43 and the procedure didn't work, I would have lost my backup (my 43-year-old eggs might be too old). Egg freezing, she stressed, isn't a guarantee. I called other centers and heard the same refrain. Dr. Mark Sauer of Columbia University Medical Center explained that although egg freezing was viable, the numbers weren't always as rosy as the ones I'd seen so far. Some women may not even produce a lot of eggs, or respond to hormone shots at all, he said. The technology is new: So far, only about 200 babies around the world have been born from frozen eggs. He added the exclamation point: "There will be some women who have nothing. They'll spend a lot of time and money and find out it doesn't work," he said.

    My stomach lurched, and I actually swooned until he mentioned that you could improve the odds if you fertilized some of your eggs right away and banked the embryos. That technology is more established and has a greater chance of resulting in live births.

    That was a great idea! But where was the advice column on how to have that conversation with your man? "By the way, I really like you and am having my eggs frozen Friday, so I was thinking maybe we could make some embryos, if you're cool with that." The other option was to stop by a sperm bank and pick up a few samples from donors, just in case. Or both. When I thought of my poor brood-to-be from different fathers waiting for a uterus in a freezer outside Boston, I felt overwhelmed. I thought egg freezing was supposed to let me put off thinking about all this stuff. Instead, it was getting messier by the minute.

    I casually mentioned freezing to my mom, who went off: "This is crazy! Your whole generation is nuts," she shouted. "Just get on with it. Get married. Get pregnant. End of story." She sort of had a point. It shouldn't be this hard. Her voice softened: "Honey, I'm not trying to harass you. It's just that I don't want you to miss this," she said. "And you'd be such a good mother."

    That's when the tears flowed. What if the eggs didn't survive? What if the IVF didn't work? I thought of my best friend from college, now making the rounds of fertility doctors. She was devastated, and I wondered if I was being cavalier with what was supposed to be one of life's seminal experiences. Would I be Very, Very Sorry?

    Over the next few months, I saw babies everywhere — in adorable snowsuits in the park, screaming in airports, gurgling in my friends' arms at holiday reunions. I took long looks into the eyes of my juicy 8-month-old niece and wondered if I could live without her.

    The uneasy truth was that I didn't know. I knew that egg freezing was an expensive risk (with hormone shots that could make me bloated and bitchy — and give me hellish cramps afterward), but that didn't change the fact that I still wasn't ready to take on a baby right now. My man wasn't ready — and if he was, he wouldn't be my man. Children are wonderful, but they can also stress you financially, physically, and emotionally. I wanted to be in a rock-solid marriage with a track record before I had kids. And I didn't want that process to be strained by some deadline that no one could really identify.

    Ironically, egg freezing might actually help my love life. Two months after Extend founder Jones froze her eggs, she got engaged. She told me of several others whose relationships moved forward after they banked their eggs. We theorized there was a "freezing effect": When you threw The Clock out the window, you relaxed, he relaxed, and life moved along as it should.

    Recently, when I told my boyfriend I was considering freezing, he gushed, "I'm so glad to hear you say that." We spent the rest of the night talking about how men feel the pressure, too. He had his own stories of first dates that felt like interviews and friends whose courtships were detrimentally fast-forwarded by The Clock. Of course, we couldn't be complacent. But we both agreed it would be nice to take my ovaries off the table for a little while.

    Even if freezing was a wretched failure, I knew there were other ways to be a mother: donor sperm and egg, surrogate, adoption, or even being a stepmother. I wasn't sure I had to have my own genetic offspring anyway, especially since my DNA carries Alzheimer's, addiction, mental illness, premature gray hair, and fat ankles.

    I turn 37 in July, and I have decided to freeze my eggs at the end of this month. Ideally, I'll start a family in a few years and never need that freezer outside Boston. But I think it would be crazy not to take advantage of all my options — especially if I have trouble conceiving a second child. Since I made the decision, the chatter in my head has calmed. I forgot how much I missed the quiet.

    Sarah Elizabeth Richards
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