At a time when women in Arabia are pursuing active, independent lives more than ever, and with awareness of health issues increasing, a rising number are opting to freeze their eggs. Could you pause your biological clock?
Originally printed in the September 2018 issue of Vogue Arabia.
Roughly every 28 days, one ovum out of a few hundred thousand starts its journey from the ovaries to the womb. It’s the largest cell in the human body – fat with nutrients – typically visible to the naked eye, and can’t move on its own. It needs all the help it can get to be in prime position to fulfill its genetic destiny – being fertilized and forming a healthy embryo. Hormones produced and released by the ovaries and pituitary gland cause the mature ovum to burst from its follicle and into the fallopian tube. While there, tiny hairlike structures called cilia move the ovum along in a life-or-death race to fertilization. If the ovum does meet the one sperm capable of breaking through its protective layer of enzymes and glycoproteins, it will travel down the fallopian tube as it divides and grows as an embryo for about five days before gently descending to the womb, where it will implant.
That’s if all goes well, of course. But what if your ovum would like to build a career first? Or maybe your ovum hasn’t met the right man yet. Perhaps your ovum isn’t even sure if it wants to be set free… What is a female reproductive cell to do? The answer might lie in the freezer.
Freezing your eggs – oocyte cryopreservation, the technical term for essentially removing a body part to keep it cryogenically safe and fresh until you put it back again when needed – may sound like a futuristic dream, but it’s been safely done since the first reported successful attempt, by Dr Christopher Cheng in Australia in 1986. The reasons to artificially preserve your fertility are legion. Some women choose to delay marriage – to work, study, or find the right partner – while others might undergo traumatic cancer treatment that would otherwise have left them infertile. Whatever the reason, the process gives hope to women who want to have children one day, whenever that day may be, but are worried about dwindling fertility. The only catch is, you need to do it sooner rather than later – preferably before the age of 35, but it’s not uncommon for women to do it in their early 40s.
Women are born with a set amount of ova – about one to two million – each one waiting its turn to become egg of the month, explains Dr David Robertson from Bourn Hall Fertility Clinic in Dubai. “Women don’t make new eggs throughout their lives. With the onset of puberty, they start releasing eggs every month. Eventually, there will come a time when the egg supply runs out and it’s no longer possible to have children normally.” On average, this will happen in the late 40s, early 50s, and heralds the onset of menopause. But in the years before then, the number and quality of the ova also start to go down – remember, these eggs have been sitting in the ovaries for a few decades, waiting to mature. “In particular, what happens is they develop chromosome abnormalities, genetic abnormalities,” Robertson says.
This is where egg freezing cracks open the fertility doors. It’s a relatively simple procedure that any woman – married or single – can have done in the UAE, provided she’s fit for it and has healthy eggs. It gives women choice and a safety net. It’s not a failsafe route to pregnancy – Mother Nature still has a strong will, even if modern-day science can bend and manipulate it more readily than in the past. But it can help take the pressure to procreate off a woman’s shoulders when she is not in a position to have children yet, whether socially, financially, or mentally. It’s a possibility Bourn Hall’s CEO, Hoda Abou Jamra, wishes she could have made when she was younger. “I tell all my friends to do it,” she says emphatically. “I regret not having that choice when I was in my 30s. It gives women options – and with options come freedom from pressure and the choice of how you want to live your life.”
Nathalie Abdou, managing director of One World Trading in Dubai, is one of Jamra’s friends who took her advice. “I decided that by the age of 38, if I was not married, to freeze my eggs. We don’t know what life has hidden for us and you could lose your fertility through illness or accident. Freezing your eggs is an insurance policy,” she says.
It may sound like sci-fi and the theater and laboratory facilities definitely look space-age, yet the actual process of extracting, freezing, and storing eggs is pretty uncomplicated. “First, you need to assess and evaluate the patient’s fertility process,” explains Dr Ahmad Fakih, specialist obstetrician and gynecologist at Fakih IVF Fertility Center in Dubai. “This is done by performing an ultrasound and a blood test. Second, a counseling session is scheduled to formulate a plan. Some patients might undergo the process once, while others might require further procedures.”
After doing daily bespoke hormone injections to stimulate multiple eggs to mature in one cycle, as well as a few visits with the doctor to evaluate the progress, about 10 to 15 eggs will be harvested. It’s not painful – mainly because you’re knocked out for the duration. “It can be done under local anesthesia but most people have some sedation or general anesthesia for it,” Robertson says. “It would be a bit uncomfortable with just local anesthesia.” The small surgical procedure takes about 15 minutes in theater, with the doctor extracting the eggs vaginally using a needle guided by ultrasound. “It’s very quick and straightforward,” Robertson says. “The hormones stimulate follicles to grow on the ovaries. It’s a fluid-filled sac with the egg inside. We can see this sac on the scan, so we put the needle inside and suck out the fluid.”
At Bourn Hall, the theater and laboratory are adjacent, with a window separating the two so the eggs can be handed to the lab technician immediately. The patient then recuperates in a private room for a few hours or overnight and might experience slight bloating and discomfort. “The process isn’t scary or painful,” Abdou says. “It just requires commitment. The only time I felt tired was after retrieval – I slept the whole day.” The entire process, from consultation to having your genetic material stored outside of your body, usually doesn’t take longer than two or three weeks. And what of your eggs? They are frozen in liquid nitrogen, after being treated with chemicals to preserve them in a process called vitrification, or rapid freezing. “Vitrification has drastically improved the survival rate of eggs to 70-90%,” Fakih says. “Before the introduction of vitrification in 2011, survival rates were as low as 30%.” Your eggs are stored on-site and can be kept until you need them, if you are Emirati, or up to five years, if you are an expat.
While oocyte cryopreservation is available to all women in the UAE, there are certain legalities specific to the region. Firstly, you cannot take your frozen eggs out of the country – it is illegal to import or export eggs, sperm, or embryos. “Even if an Emirati national has frozen her eggs, if she moves to Saudi Arabia, she can’t take her eggs with her,” Robertson explains. There’s nothing in the law that prevents a single woman from freezing her eggs but she can only use them to fall pregnant with her husband when she is married. Getting pregnant the natural way is not possible with frozen eggs – you have to do IVF treatment. After thawing, the egg is fertilized in the lab with one of your husband’s washed and cleaned sperm. The fertilized egg will grow in the lab for about five days (the same amount of time it would normally spend in the fallopian tube before implanting in the womb), after which the doctor will place it using a tube into the womb, which has been fooled by hormone injections into being ready to accept it.
It’s important to note three things if you are contemplating freezing your eggs: one, the earlier you do it, the better; two, it’s not cheap; and three, it’s not a guarantee of a healthy pregnancy. To get the maximum benefit from it, you need to do it before 35, because your egg quality will be better (the average age of women doing the procedure at Bourn Hall is 38). With every birthday, fewer good-quality eggs will be available. “The younger you are when your eggs are frozen, the higher the chances of success in the future, since younger eggs are always healthier,” stresses Fakih. “Age is the ovaries’ worst enemy.”
Abdou agrees: “I keep pushing my friends to do it. It’s brought me peace of mind.”
The test for your ovarian reserve at Bourn Hall Fertility Clinic is AED325, which anyone can do regardless of whether they decided to freeze their eggs or not. A complete hormonal profile and ovarian reserve test costs AED700 and the egg freezing cycle is AED18 000. Bournhall-clinic.ae, Fakihivf.com