Six months ago, Hyderabad-based businessman Aman Verma and his banker wife Shikha (names changed on request) decided that they needed a different kind of 'insurance'. Shikha, who is in her mid thirties, says her job requires her to travel frequently. Aman, who is a few years younger, says both he and his wife are "too busy" to consider starting a family just yet. "But I had heard about fertility problems later in life. So we went on the internet to search for alternatives, and found the idea of freezing my wife's eggs a good one," he says.
Freezing Shikha's eggs could mean that, in a few years, when the Vermas are ready - and if they are unable to have a child naturally - they could turn to her frozen eggs stored at the Kiran infertility centre in Hyderabad, get them thawed, and after the in-vitro fertilization (IVF) procedure, implant the embryo in Shikha's womb. Her chances of getting pregnant through this method would depend on several factors including the quality of her eggs at the time of banking.
Typically, it takes one or two cycles of extraction to get a good number of eggs from a woman's body. The Vermas are aware that the success rates of IVF is about 25-30 per cent per cycle. "It would be best to have a baby the natural way. But if we can't, with egg freezing, we would at least have an option," says Shikha, who is keen to wait another five years before planning a child.
Dr Samit Sekhar, executive director of KIran infertility centre, says there are at least 17 other women whose eggs are stored in the clinic's egg bank. The first woman to get the procedure done at the clinic two years ago was a 29-year-old airline professional, who believed her job wouldn't allow her to have a baby just yet. She believed that the option of freezing her eggs allowed her to consider postponing motherhood for a few more years.
Other doctors such as Mumbai-based Dr Duru Shah, describe egg freezing or oocyte cryopreservation as an "empowering" alternative for women whose career aspirations take precedence over having a baby, or, for those who believe they haven't found the "right partner" yet. Egg freezing provides a "safety net" to these women, she says.
Shah says that the procedure allows women to be choosier about their partners. "Isn't it better than rushing into a marriage?" she asks. "All these women really want to have babies. Of course, it would be best if they had it naturally. But this option gives them choice. It's just like contraception," she says.
Recently, in a bid to attract more women employees, Facebook and Apple announced a host of benefits, including the offer to freeze eggs. Since then, the subject has been hotly debated in the media, on blogs, and at workplaces.
While many - not all of them social and religious conservatives - view this, like surrogacy, as a tricky ethical issue that could have unforeseen repurcussions, and as yet another indication of mankind's Icarus-like attempts to overreach itself, there are those who believe it is a great stride forward. Advocates of egg freezing believe the procedure will bring about an attitudinal, even a social paradigm shift comparable to the one affected by the pill 55 years ago.
Incidentally, one of the doctors on the team that developed the pill was, ironically, trying to treat infertility. The pill gave women greater reproductive autonomy, allowed them to plan their families, participate more fully in the work force and therefore improve living standards of their families. Advocates of egg freezing believe the benefits of the procedure are comparable to contraception.
"This is like reproductive insurance, and we have to respect the choices that women make," says Dr Aniruddha Malpani of Dr Malpani infertility clinic in Mumbai.
But like all contemporary hotbutton issues that force individuals to confront their sexual and reproductive roles, there are as many pros as there are cons. While some women, conscious of the documented negative effects on their careers of their motherhood breaks and even their status as mothers, might want to 'have it all' by freezing their eggs, the procedure is an even greater boon for cancer patients whose eggs are destroyed by radiation therapy.
Contrary to general belief, however, egg freezing is not as simple as popping a pill. To begin with, it is a medically invasive process, and extraction costs amount to about `1 lakh, with an additional storage cost of about ` 40,000.
FROZEN IN TIME
While sperm freezing has been around for several decades, egg freezing is a recent phenomenon. According to Rene Almeling, author of Sex Cells: The Medical Market for Eggs and Sperms (2011), human sperm banks were established in Los Angeles in the 1950s, though commercial sperm banks with donated sperm didn't open until the 1970s. In an email interview with this reporter, Almeling explained that the demand for frozen sperm (though it does not work as well as fresh sperm) increased after the AIDS crisis of the mid-1980s, when physicians were encouraged by the American Society of Reproductive Medicine (ASRM) and FDA to begin using frozen sperm. "Eggs have a higher water content than sperm so it took much longer to figure out how to successfully freeze and thaw eggs."
Almeling, assistant professor of sociology, Yale University, sounds a note of caution that those considering postponing motherhood should perhaps heed. "Egg freezing still has very high failure rates, and so the ASRM considered it an experimental procedure until 2012, and still does not recommend it for delaying motherhood," she says.
This view is reinforced by the ASRM website, where a 2013 document on egg freezing states that "data on safety, efficacy, cost-effectiveness and emotional risks of elective cryo preservation is insufficient to recommend" the procedure for those who wish to bank their eggs in the absence of a medical condition. While stating that the technique is no longer experimental and may be used to simplify egg donation, the document also states that "marketing this technology to defer childbearing may give women false hope and encourage delay in child bearing".
Also read: Keep the frozen eggs but ask for more
Despite that, however, in the US, the procedure is being promoted aggressively by egg banks, who organize egg-freezing-themed cocktail parties, where women come to, literally, "chill" over drinks.
In India, doctors claim that egg banking to have biological children at a later date is restricted to a minority and that only about two of the women who enquire about the procedure actually opt for it. Most of these are urban professionals in their mid-to late 30s who haven't yet found someone with whom they'd like to have a family. Mumbai-based Dr Nandita Palshetkar recalls the case of a 40-year-old who hoped to have a baby at 48.
Palshetkar says that she doesn't encourage that much delay as, "with eggs, the younger the woman, the better the egg quality." "The 40-year-old woman's ovarian reserves were good so I went ahead with the procedure. But usually it's best if they come in their early 30s," she says. Shah wishes women came to her earlier. "Many Indian women from the US come to me after they are 35. In the US, menopause sets in later, while in Indian women, it sets in earlier. They need to be in their early thirties, or even under 30 for their eggs to be of good quality."
Timing is key. Ensuring that the eggs are banked at the "right" time means women have to worry about the health of their ovarian reserves. This is done by measuring their fertility through the anti-mullerian hormone levels in their blood.
Better egg quality means that the chances of a successful pregnancy later are also higher as, because in vitrification (see graphic), most of the eggs (doctors may extract upto 20 eggs) will survive. "The survival rate of eggs is about 70-80 per cent. How many will turn into an embryo will depend on the egg quality. People come with high expectations and need to be counselled on that too," says Dr Nalini Mahajan of the Delhi-based Nova IVI fertility clinic.
A WOMAN'S PROBLEM?
Dr Harsh Vardhan, Union Minister for Health and Family Welfare, believes the complications of the IVF procedure are underrated. In a comment piece in this paper earlier this week, Vardhan stressed on the "physical and psychological trauma" that women who go for Assisted Reproductive Technologies face as the process is "unpredictable and repetitive".
Delhi-based communications professional Shruti Raina (name changed on request), 35, who had a baby last year (after three IVF cycles in a year), says that even though she considers the treatment "a boon" for infertile couples, the journey was tough. The process of extracting eggs took about about four weeks and required her to self-inject hormones at precise times, she recalls.
Also read: Frozen eggs are no guarantee, really!
"If the time is 4.09 pm, then it had better be done right then! I remember I was once busy at work and my husband had to travel to my office with the injections in a freezer box just so that I could inject myself on time!" says Raina, who succeeded in getting pregnant in the third IVF cycle. "It was very unsettling. I couldn't enjoy my pregnancy like other women do, because I was told that IVF pregnancies are more complicated. Those who are freezing their eggs now also need to factor in the financial and emotional costs that come with IVF," she says.
Despite the fine print, however, the procedure is generating some interest among urban Indians. But to see this as a "woman's issue" would be reductive. In the Indian Journal of Medical Ethics, Dr Imrana Qadeer, retired professor, Jawaharlal Nehru University, writes that though male infertility is about 40-50 per cent of the total infertility in the country, the burden of infertility falls on the woman, who ends up undergoing the invasive procedures. The situation could be exacerbated by egg freezing. "The point is, do we want women to undergo medical procedures so that they can work longer hours, or do we want to think about structural solutions, such as reasonable work hours, paid parental leave, and paid childcare?" wonders Almeling.
The latter suggestion would find favour with both Shikha and Shruti.
Dr Samit Sekhar, executive director, Kiran infertility centre, Hyderabad
Dr Duru Shah, scientific director, Gynaecworld Mumbai
Dr Nandita Palshetkar, Bloom IVF, Mumbai
Rene Almeling, Assistant Professor, Sociology, Yale University