Forty may be the new 16, Sridevi may be the new Priyanka, but time is unforgiving for women. Come 40, your eggs will dry up. That tick-tock of the biological clock sounds much closer, shriller. But modern medicine has changed the rules of the game.
For Mumbai-based banker Nandini, who does not want to disclose her last name, it was never a question of choosing career over motherhood, but of waiting for the right person before having children. “I always wanted children. I just wanted to have them with the right man,” says the 43-year-old. “My career was going great and I did not want to rush into marriage. I would look at pictures of these post-40s celebrities having babies and dismiss the warnings about delaying babies.” All that changed when she met up with an old college friend. “She told me of her struggles to conceive after marriage and that frankly got me panicked,” she recalls.
Her friend’s experience pushed Nandini to seek what is medically known as oocyte cryopreservation or egg freezing, a technology that helps women freeze their healthy eggs—“just like sperm banking, only that is simpler,” says Bina Vasan, head, reproductive medicine, Manipal Andrology and Reproductive Services, Manipal Hospital, Bangalore. “Here the ovaries have to be stimulated to produce the eggs and they are later retrieved under general anaesthesia.” Worldwide, as in India, egg freezing is medically recommended for infertile couples, those with poor ovarian reserves, or for women with early stage cancers who are exposed to chemotherapy, which destroys eggs.
Of late, fertility experts say, a large number of those coming forward are women with “social” reasons; those who haven’t found the right man yet or want to put motherhood on hold while they focus on their careers. “We are seeing as many as three-four single women every month, in high-profile jobs, who have not yet found the right partner, coming forward,” says gynaecologist Duru Shah, who consults at some of Mumbai’s top hospitals.
Egg freezing is not new in India, but it has become more effective in recent years with the introduction of vitrification, a specialized freezing technique which ensures ice crystals do not form within the egg and damage the cell structure. “Eggs, unlike sperms, are fragile and the earlier method of slow freezing would damage them,” says Dr Shah. “Now with vitrification we are getting good results.”
Until late last year, egg freezing was termed “experimental” by the American Society for Reproductive Medicine. That was lifted after several studies established that pregnancy rates with frozen eggs were similar to that with fresh eggs. Few of these studies, however, have looked at women over the age of 40.
“With the refinements in technology coming in, a large number of IVF clinics which have mushroomed across the country are pitching this method to women who want to delay babies for non-medical reasons,” says Kiran Coelho, head of gynaecology, Lilavati Hospital and Research Center, Mumbai. “And because we don’t yet have clear guidelines on assisted reproductive technology, they are going unmonitored,” she points out.
Choosing the right time
There is no study as yet in India to show how often the eggs yield babies. At Rs.2 lakh, the procedure does not come cheap, with hormonal injections making up the bulk of the cost. “These days many women don’t find a partner until they are in their late 30s,” says Nandita Palshetkar, infertility and IVF specialist at Mumbai’s Lilavati Hospital and Delhi’s Fortis La Femme Hospital. “Sixty per cent of women over the age of 40 find it difficult to conceive. So they come and bank their eggs. I have a couple of patients who banked their eggs when they were in their 30s. They still haven’t found a partner so they are now planning to have a baby with a sperm donor. With awareness growing about this technology, many women are coming forward,” she adds.
Dr Shah meets at least three women every month who want to freeze their eggs for social reasons. “Not many follow through given the cost and the complexity,” she says. “The average age of menopause for Indian women is 47. The fact is that 10 years before you reach menopause, good-quality eggs are gone. We have women coming to us at the age of 37-38, and by then there are hardly any eggs left. Or they are not of the best quality, so we discourage them.”
A message that experts say fertility centres need to be more upfront about. “Last October, I attended a conference in Los Angeles (US) organized by American Society for Reproductive Medicine, where a number of experts talked about how egg freezing makes sense when the woman is at her peak fertility, which is below 30,” says Dr Coelho. “These methods are still under research. We need more information on this. The point is that most IVF clinics in India rarely accept eggs from a 40-year-old. Most women post 40 have a low anti-mullerian hormone (the hormone that estimates the remaining egg supply or ovarian reserve). This means they will produce lower amounts of eggs or oocytes. Women who come forward for egg freezing need to be made aware of this.”
That awareness did not discourage Nandini when she froze her eggs two years ago. “For a month I felt like my life was on hold,” she recalls. “I was given injections every day for a fortnight as I was over 40 and not producing enough eggs. I had severe water retention and hot flushes.” Nandini, who is still single, thinks it was all worth it. “Well, I stopped being madly stressed out about it. When I am ready I will have my baby. This way I feel that I have a small chance at the very least.”
“Ultimately it’s all about choice and that is what this technology gives you,” says Mumbai-based journalist Anjali, 34. She plans to monitor her egg count every year and opt for the procedure when the time is right (the egg count can be checked through regular ultrasound tests which cost about Rs.2,000). “I am not married but I definitely want to have kids. This empowers women in a sense. You don’t feel so trapped by your biological clock.”
Among the numerous variables that a woman juggles with, career and children are probably the toughest. While this remains as hard as ever, technology has now given women a bit more control.
Shai Venkatraman is a journalist, teacher and blogger with a special interest in issues related to health and gender rights.