Worried about the conflicting demands of professional ambition and starting a family?

Consider egg preservation so you can invest in your career but keep your fertility options open.

Sometimes in life we have to look at our assets and see if we need to change our investment options and look at our future. This is not only the case for our financial assets but also for our biological ones. We know that fertility is best when you are young, and that for both men and women it declines with age. Let’s speak about this and look at what is going on with the eggs.

What is the story about your eggs?
Women are born with a finite number of eggs, around 1-2 million. At puberty, that number has dwindled to 300,000 and subsequently approximately 750 eggs are lost each month by a process called atresia. The eggs not only begin to diminish in quantity, but especially also in quality. 

The combination of these factors leads to a woman’s fertility beginning to decline in her 20s and significantly deteriorating after age 35. The chance of conception for a woman older than 43 is very low. Even modern fertility techniques like IVF cannot overcome this problem. Once there are no eggs anymore there are no eggs anymore. And many women who want to have a baby in their forties will stay childless or they have to resort to using donor eggs from a young woman. 

How can we measure your current stock? 
Your ovarian reserve is the quantity of eggs left in your ovaries. This can be determined by undergoing a normal ultrasound of the ovaries. 

The ovarian reserve is further assessed by measuring the levels of two different hormones. This is measured by a blood test performed following the first few days after starting a new menstruation. These two hormones are follicle stimulating hormone (FSH) and anti-mullerian hormone (AMH). When FSH is high, and AMH is low, it signifies that your egg reserve is depleted. 

So, with the current technology doctors can have a very good idea about the amount of eggs that are available in the ovaries. We can measure how much you have. But not all assets are equally valuable, and these tests only detect quantity but not quality. 

What about the quality of the eggs? How can we measure this? 
There is only one good predicter and that is age. Even if there are still a good number of eggs it doesn’t mean that they are healthy. The quality of a woman’s eggs starts to decrease after the age of 35 very quickly. There is not much that can be done to prevent it, although a healthy lifestyle certainly is always helpful. 

That sounds very depressing 
Life expectancy has increased drastically over the past 100 years and many women prefer to wait to have children for personal or career reasons. In developed nations, the average age of giving birth to a first baby is now 29. It has also been observed that women who are graduates have their first baby much later than women who did not study. This leads to more women having fertility problems. It is probably the most important reason why infertility has increased in the last few decades. 

Adverse pregnancy outcomes also rise with age, and women over 40 are at a significantly higher risk of pregnancy complications like miscarriage, diabetes and hypertension during pregnancy. Many modern women in their forties are healthy, very fit and full of energy. However the ovaries can’t keep up with this and they still aging and the same rate. Unfortunately, our hearts' desire and our desire for lifestyle choices are very different from our biology.  Women over the age of 35 are considered by doctors as advanced maternal age. Sounds terrible and depressing indeed. 

Oops, should I have that baby now? 
There are many very good reasons to postpone pregnancy: Focusing on your career, finishing your degree, waiting for the right partner or waiting until you are in a financial and emotional position to support a child. These are all very good arguments. So is there anything you can you do to preserve your shares and do some asset protection? Well, yes you can! There is now the very well established procedure of egg freezing or egg banking. 

It’s a man’s world 
The age factor is best understood for women but there is now also more and more evidence that men are also affected. The decline of male fertility is however much slower and not as sudden as for women. Many men in their forties can easily become a father. On the other hand, there is more and more evidence that older men have an increased risk of having children with autism, bipolar disorder and schizophrenia.  

When should you freeze your eggs? 
Most people have this perception that egg freezing is for 'older' women or unmarried women. In fact, because egg quality deteriorates quickly with age, it is best to do it before 35 and the ideal age is probably around 32-33. Unfortunately, many women wait until they are around 40 for egg freezing and then, it is much too late. 

Where should you go to freeze your eggs? 
There are professional egg preservation clinics that will support you through all the steps of preparing for, extracting and preserving your eggs. 

What usually happens in the first consultation? 
We have a chat, perform an ultrasound of the ovaries and do a blood test to evaluate your ovarian reserve. 

What does the egg freezing procedure entail? 
After the initial consultation, the next step is ovarian stimulation. Injections are usually started on the third day of a new menstrual cycle and must be continued daily for 10 to 12 days. You can inject yourself. However, it is possible to start the ovarian stimulation at any time of the cycle. The doctor will do several ultrasound examinations to determine the best time to retrieve your eggs.

The egg retrieval is a small and painless operation under sedation with no hospitalisation needed. You can be discharged after two hours, and you will only need to take one day off work.

After your eggs have been retrieved, they are prepared in our laboratory by the embryologist who evaluates the appearance of the eggs and begins the process of preparing them for freezing by a rapid freezing technique called vitrification, which gives the highest success rates. The eggs are then stored in the laboratory in a liquid nitrogen container at a temperature of - 196 degrees Celsius. 

How long can eggs be stored? 
Very long. There’s no significant time limit and they do not depreciate over time.

Is egg Freezing Safe?
The current evidence states clearly that no increase in chromosomal abnormalities, birth defects, or developmental deficits have been noted in the children born from frozen eggs to date. In 2012, the American Society for Reproductive Medicine lifted the "experimental" label from egg-freezing. It is now a common and well-established procedure in reputable fertility clinics. 

What does it cost? 
In the US the costs are high at more than $10,000. Therefore companies like Facebook, Apple and Google offer this now as a perk to their female employees.  In South Africa it is also not cheap at around R40,000. This usually includes all drugs and one year of storage fees. 

 This article is sponsored by Ferring Pharmaceuticals. 
 Helping people live better lives
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Ferring (Pty.) Ltd. Route 21 Corporate Park, 6 Regency Drive, Irene Ext 30, Pretoria, South Africa. Tel: +27 12 345 6358. Fax: +27 12 345 1156. www.ferring.co.za. FERRING, and the FERRING logo are registered trademarks of Ferring B.V. 2019/097 Date of preparation: November 2019.