Why more women are freezing their eggs | DW Documentary
Everybody knows that children are a big commitment in financial terms too. But what's not common knowledge is that making babies or effectively freezing the desire to have children can be a profitable undertaking. In 2014 a story about Big Tech companies paying female staff to freeze their egg cells made global headlines. Tech giants, Apple and Facebook say they will foot the bill for employees Facebook will pay for their female employees to freeze their eggs women who elect to freeze their eggs Less than 5 years later, a major American fertility services firm called Progyny celebrated its flotation on the stock market. The fertility sector was officially open for big and lucrative business. When I got into fertility, I raised that first hundred million and it went very well I was on the cover of Forbes magazine when we raised the money.
Health care is a growth business, and everybody will always need health care and as we get older we’re probably all going to need more health care. But of course, the fertility world is very commercialised already. Online ads promoting the baby-making industry now seem omnipresent. We’ll do everything we can to make your dream real.
Money also plays a role, of course. Each puncture costs between 2.5 to 3000 euros. I think private equity money is interested in the fertility industry for a number of reasons.
When people want to have children, they prioritised their expenses in relation to reproductive treatment, even if there is a recession. As an ova bank we want to offer our services in countries around the world provided it's legal there. In the future sex will just be sex, and children will be made via IVF. I am a technology entrepreneur, focused on health care and focused specifically on fertility.
I started getting involved with the field of fertility when my wife and I had difficulties having a baby. So we entered the field of fertility as patients, we then successfully had 3 children, and while being a patient in the US because this was happening in the US, in Miami while at the waiting room of the fertility clinic, I felt I thought like a tech entrepreneur: this is just so poorly organised. I felt fertility could be greatly improved. A growing number of people are keen to postpone having children and when they do want them, it often turns out to be a very difficult process an experience that Martin Varsavsky knows first hand. But being an entrepreneur, he also saw a business opportunity.
He became a major market player, offering a technological solution to a biological problem. I think having a biological clock made a lot of sense when people died at 35, which is only a 150 years ago. We now have the first generation of women who will spend more time in menopause than they spent fertile. So why should women pack all their children very early in such a long life? I think we will be able to get rid our biological clock by what Prelude first now, my clinics and many other clinics, but we are the Number One group of clinics in the US, which do eggs freezing. We were the leaders in eggs freezing in the US and eggs freezing is a very good way to stop the biological clock.
If you think of fertility as a bread and an oven, meaning the embryo is the bread and the uterus is the oven, the problem: 95% of infertility cases of women are with the bread, and 5% with the oven. The oven works. Of course: it doesn’t work well if you don’t have enough eggs. People want to party and have a good time and work. Spain has the lowest fertility of Europe, together with Italy. So by the time Spaniards want to have babies they have to go to an IVF clinic.
Many of them. To give you a sense: the United States has 330 million people and it has 200,000 IVF cycles. And Spain has 45 million people, and has a 100,000 IVF cycles. So the Spanish are to fertility what Germans are to cars.
I don’t know, it’s something that well the fertility science has grown very well in Spain. Spain has developed into the hotbed of fertility treatment in Europe, offering lots of private clinics for in-vitro fertilization or "IVF". When — as Varsavsky puts it there’s nothing wrong with the woman’s ‘oven’, but the "ingredients" you're working with are past their sell-by date, there's a solution for that too Egg cells stored in a bank. In 2012 there were no ova banks in Europe. I came from the United States, after having worked there and in Italy.
I had a number of patents related to freezing egg cells. And then we came up with the idea of setting up an ova bank which we opened together with our first fertility clinic in Marbella. It seemed interesting — because while there were sperm banks, there was no equivalent for egg cells.
Follicles develop naturally in the two ovaries. They receive growth stimulation from a hormone called FSH. The follicle grows and grows and when the egg inside it is mature and reaches a size of 18mm, it bursts open — and the egg separates itself from the ovary. When that follicle is discharged during menstruation, new follicles are created. They're stimulated by the FSH hormone. And while many follicles are created, the FSH is sufficient for just one single follicle which continues to grow, while the rest ... disappear.
That follicle keeps on growing and the egg detaches itself and migrates along the fallopian tube and leaves the body naturally via menstruation. We artificially administer the FSH hormone, so that not just one follicle grows but all of them. Once the follicles are 18mm wide, we take the patient into surgery.
We then puncture the follicles to remove the fluid and the egg. And then, in the lab, we extract the egg cells. We gather all the eggs that the woman would otherwise have discharged.
So in that sense, it's a harmless process. A woman will lose 40, 50 or 60 eggs every single month. By her late 30s, a woman's egg-cell count is low — which is sad, but that's why we're here. This is what we do. We're now going to puncture the follicles you see in black in order to extract the egg cells.
We're bringing the needle into position and then we'll puncture the follicle. In the 1990s the Dutch government launched a campaign, complete with TV commercials, called “Smart girls prepare for the future”. The idea was to encourage young women to become economically independent by planning ahead and making a career for themselves.
These days, women who wish to postpone having children can have their eggs frozen and stored for the future. This café in the Netherlands was set up specifically to inform women about this option. Evidently the new motto is: “Smart girls prepare to freeze time”. Welcome to the "Kinderwenscafé".
For women who want to freeze their egg cells. I added pictures to the presentation, to make the magic easier to appreciate for non-experts. A growing number of women are seeing their fertility decrease with age. The older you are, the lower your chances of getting pregnant. You're not fertile forever. Sex education in secondary school is mainly focused on how not to get pregnant.
But nobody talks to us about it! We spent so much time trying to prevent unwanted pregnancy, that we’ve forgotten the other side of family planning, and actually telling and educating women about the impact of time on their biological options. And if you look at the strategies and the campaigns to reduce unwanted pregnancies in teenagers they’ve been hugely successful. But have we failed the generation of women that have now got into their forties and decide they now want to have children, and realise that the biology has been against them.
Stuart Lavery is a London-based fertility specialist. Many women have come to him seeking IVF treatment only to discover that they had left things too late. Lavery started his own private clinic, offering his clients the technology for freezing their egg cells. The huge thing that women have had to deal with for generations is the age-related biological clock, that has bene ticking. And the science is currently available to allow those women the options storing their eggs, potentially to use them in the future.
And I think probably the closest thing to this is what happened in the 1960s and early 1970s, with the advent of the old contraceptive pill. It gave women power, it gave women choice and autonomy over their own reproductive lives. About deciding when maybe they didn’t want to have a baby. This technology may be the flip side of that coin.
And it may be the ultimate in family planning, to allow you to have a baby at the time of your choice. A lot of women I know don't want to have made a commitment at a certain age. They want a career, an education, options for further development and to travel but they're held back by biology. When I was in my early thirties I wasn't thinking about having children. I thought there was still time for prince charming to turn up.
Until you get older and realize I know I want children, but not until I grow up. Sometimes I realise that I am already pretty grown up. It's weird. Everybody knows it — but it's just like you said I wasn't thinking about it when I was 30. What’s really attracted me to this field of egg freezing has been my experience in looking after women coming in at age 42 trying for their first baby.
And the reality of us being able to help those women and help them have a baby at age 42. It’s really low. And it is not unusual for women to say to me: I wish I had frozen my eggs at 28, and could use them now and have a really high chance of having a baby. Almost all the follicles are empty. Storing your eggs for the future is a relatively new option. In the Netherlands for example, it's been legal for only a decade.
Women for whom it was too late to have their eggs frozen can still turn to Enrique Criado a Spanish embryologist who had the clever idea of establishing a donor bank. I'll now show you the room where we prepare the containers and from where we send the egg cells to the various clinics. This is the shipping department, where the containers are prepared. We put the egg cells in the containers and make sure they're sent to the right clinics.
We have a lot patients outside Spain looking for an egg-cell donation from the likes of Italy, Britain, France, Germany and the Netherlands. Those countries all have different laws. In many countries, egg cell donations are illegal or rendered extremely difficult by law. Or there aren't enough donors so patients from those countries come to Spain because we do have enough. Why is that? We've been doing this here in Spain for years. These days, you won't find a woman around the age of 20 who doesn't know what an egg cell donation is.
In Spain, you're allowed to use ads to find donors. Opening the Ovobank was like opening Pandora's box! We had no idea what the repercussions would be Marbella has a great genotypic diversity. We have Russians, Norwegians, Spaniards, Italians, French and Austrians over 150 nationalities here.
We're professionals, so when assigning donors, we make sure they're as similar to the patient as possible. If a patient is blonde with blue eyes, we won't give her a brunette donor. What can you say about the value? Do egg cells have a specific value? No. In legal terms they have zero value. Egg cells don't cost anything, and you can't buy or sell them. But here? Nowhere — in Europe, at least. It's more commercial in the US.
Egg cells cost money there — maybe 5000 dollars, for example. How do you determine the value of an egg cell? In the US, eggs from an intelligent, blonde woman with blue eyes from California cost more than those of a brunette from Miami. One donor costs more than the other.
Why? It's a question of supply and demand. Patients will pay 20 or 30,000 dollars for a blonde donor from California but only 5,000 for a donor from Miami, because of the lower appeal to them. It's a different world. Following me now from Cambridge in the UK is Dr. Lucy van de Wiel, a research associate at the reproductive sociology research group at Cambridge University, and author of Freezing Fertility.
Lucy, thank you so much for your time. So with this new research, should we stop regarding the age of 35 as a fertility cliff? The question of 35 is also very much not just a biological question but a social question. It’s linked to a history of being, of concern, about the biological clock.
And that issue of the biological clock is Lucy van de Wiel is conducting a study on how our ideas and actions concerning fertility are changing thanks to these new technologies billed as enabling women to turn back their biological clocks. What’s really interesting about egg freezing is that is has changed our idea and our feeling around fertility. There's this sense we kind of become infertile earlier. Because the decision about should you treat yourself now in order to avoid infertility in the future is something that has become relevant at increasingly early ages. And at the same time the idea that when egg freezing wasn’t available, the idea that at some point you lose your fertility and that’s over is now also changing in character, because it can become something like: oh, if only I had frozen my eggs I could have conceived a child now. Or I'm trying to get pregnant, it doesn’t work, if only I had frozen my eggs ten or five years earlier.
So there is this kind of dynamic that there is more agency around it, and a different experience of fertility as something that infertility becomes more relevant earlier on, but also fertility stays relevant later on in life as well. The only certainty you're buying is having a chance later in life that you’d normally have now. That's the only certainty you're buying. What happens with egg freezing is that that more uncertain idea around fertility or the idea that you have to manage it rather than that it’s just a given, is something that comes with an increased sense of risk but also in order to mitigate that risk, you become dependent. You become dependent on technology.
You become dependent on companies. You become dependent on doctors. And so I think while sometimes it is presented as a way of being empowered, you also become more dependent. And it also means that you have to then invest and undergo particular medical risks and also financial risk in that respect. So yeah, it is definitely a double-edged sword. That brings up my next concerns.
You decide to have egg cells frozen. Otherwise, nothing's happened. It doesn't impact your life. I always thought: I've frozen my eggs, and now I'll see what happens. But at some point I realised I did it for a reason — to become a mother. That makes it more real.
You get the feeling: I've said A, so now I should perhaps also say B. It gave me reassurance, but not as long as I'd hoped. One of the reasons that I almost didn't do it was that having the option of getting pregnant up until I was 49 unsettled me.
Because either it's meant to be or it's not. Having the option was a luxury problem. It made it difficult to make the right decisions. I couldn't stop thinking about it and to be honest, I still can't even now. Essentially, you're postponing a decision in order to have more time to think about it You're creating a sea of time.
to think about it — which is what bothers me. I also thought: It might calm my mind to decide not to do it and close that chapter. I think it does bring extra pressure and extra choices on women. And although usually I think having choice is a good thing, there is no doubt that sometimes choice brings more anxiety. But there is concern around the commercialisation of this.
Because many women who are freezing will not need the eggs. They will get pregnant the old-fashioned way, with a partner. And so we have to be very careful about persuading women to do this, when most women probably won’t need it. And I do have concerns where organisations are run purely as commercial businesses, where the drive may be to advertise based on fear. And that’s certainly not the right way we should be handling this. She's known as the egg whisperer.
Glossy online commercials target hip millennials. Everyone knew that they can freeze eggs, just like everyone knows that they can get their boobs done. The marketing promises guaranteed fertility in the future while bandying about catch-words like "self-determination" and "empowerment" all with an appealing veneer of viable success.
In the US they have some companies that mainly try to shift the focus from the group that currently freezes their eggs to a younger group of women. And so the idea is that they would convince women, say even in their twenties, to freeze their eggs. Sometimes this is explained with an idea of peak fertility. So rather than freezing fertility in general they say you should freeze your fertility when you are at your peak. And then they would use marketing techniques like, for example, one company has fertility vans.
A little bus that drives to city centres, in New York and San Francisco for example. And then they also offer free fertility testing. So women can then have their hormones checked to see how fertile they are.
And so that’s one way in which it’s presented, and then one of the things that they say, for example, in that context would be “you will never be more fertile than you are today”. So there’s really that sense of you have to catch your fertility now before it’s too late. And if you are never more fertile than you are today, then every day you're virtually losing your fertility. So it’s kind of instilling the sense of urgency and it is often combined with a sense of empowerment: we are empowering you to take control of your biological clock. But there’s also the instilling of concern about it, where maybe there wasn’t any concern before.
If you talk about a company that would like to have more patients, then this would be a way of recruiting more people and making more people into patients. Making babies used to be cheap and still is for most people In the bedroom, at no cost. But we’re now made to think that we need to invest in our fertility. For later. It's a market that plays on our fears about the future a kind of "insecurity capitalism". I think private equity money is interested in the fertility industry for a number of reasons, and one of them would be egg freezing.
But also because fertility treatments in general are becoming more popular across the world. So more people are using all sorts of reproductive technologies. It’s also something that’s called "resistant to the recession". And if a key goal of a fertility clinic or fertility group is to grow, then egg freezing offers an opportunity to do that, because you can have more patients coming in for egg freezing specifically. The British Pregnancy Advisory Service or BPAS is a charity organization aiming to offer an alternative to the growing commercial fertility industry that makes so much money from people’s hopes and fears. For over 50 years BPAS helped women to terminate unwanted pregnancies.
But today it is literally building a non-profit fertility service for IVF treatment and freezing egg cells. We will have three beds, here, and then there is station, for the nurses who will be looking after the patients. And then we will egg-collect and the chips with the fluid will be passed into the lab, here, for us to look for the eggs.
There'll be a door here? Yes. This is actually going to be the first British not-for-profit IVF service. This is the hub.
It’s really exciting. Yes. I had a bit of a problem with the issue that the private patients were paying in an NHS setting the prices that were being asked for in the private sector. And a lot of the financial gain that the hospital was making was being used to supplement other departments. And often it's the medical doctors who own the fertility services, and they all get the financial gain out of it. And in my view, you know, that that is something that I am very uncomfortable with.
Once you started the treatment it is impossible to get out of it. You are in a conveyor belt. So if people are offering you things that might help it’s basically impossible to say no. And those often come at an extra cost, so it is difficult for a patient to budget for their fertility treatment. And we think that this is part of the challenge that people go through as well. The financial burden and the financial implications of not knowing how much money they’ll have to pay.
One fertility specialist in Britain claims to have an even better solution for freezing eggs and an alternative to the painful procedures otherwise involved. I’m professor Simon Fishel. I come from a background in IVF, In Vitro Fertilisation, being around at the very beginning over 40 years ago and part of the world's first IVF clinic, in fact. When Louise Brown became the world's first IVF baby in 1978, there was widespread outrage.
A baby conceived in a test tube! or, to be more precise, in a petri dish. But that opposition never deterred the then young doctor Simon Fishel. He’s now planning to market a treatment originally used to help female cancer patients retain their fertility, but which is now commercially available for any young woman. This is how fast the world is changing we live in a world where we can freeze eggs.
But it was only about 10 years ago you couldn’t really freeze eggs. You could do it but it was unsuccessful, it wasn’t efficient enough for you to offer as a proper medical procedure. So there was no option to freeze eggs. So what people were doing years before that, they were taking a bit of ovarian tissue, because we know that’s where the eggs are. And a woman is born with all the eggs that she’ll ever have, in fact she’s born with a lot more than she needs. Maybe about two million, and over time they start to deteriorate, she gets to the menopause, she’s got none left.
So a woman has this "pool" of eggs, as we call it. It was believed that you could take that pool of eggs and take some of the ovarian tissue out, you could cut it up into tiny little pieces, and freeze it. Years later, when she wanted to have children, you would take out the ovarian tissue, put it back into the same woman, and it would start producing eggs. Those eggs could be fertilised and she’s fertile. So they have preserved her fertility. There’s another problem out there.
Not just preserving fertility now here’s the interesting thing: if you want to stall your fertility, then you put it back near the reproductive organs, so you can try to conceive naturally. But if you just wanted to restore your hormones, you don’t need to put it back near the reproductive organs. You could put it anywhere where there is a blood supply. You could actually put it under the arm pit, for example.
And as long as it has a blood supply it will kick start within about 3 months and it will start producing the hormones. One revolution has barely been absorbed and the next miracle is already being announced — the freezing of ovarian tissue a development that would make it possible to delay the menopause. Simon Fishel is one of Britain's leading fertility specialists. According to him, the waiting lists are long.
Probably it’s worth thinking that maybe the best we can do at the moment might be to prevent the menopause coming on for maybe 20 years. Even though let’s say it should have started when you are 50 and you’ve frozen your tissue when you were 30, you may get enough opportunity to keep your hormones going to prevent the menopause maybe until you are 70. Eggs freezing has revolutionised egg donation as well.
So that’s moving eggs from one woman into another woman. Previously you needed to have the two women in the same room, around the same time, in order to do that procedure. But now that you have frozen eggs, you can move the eggs across time and across space.
So technically a woman can donate her eggs in one country and a woman can receive those eggs in another country if the eggs are shipped in liquid nitrogen tanks from one place to the other. But you can also have a much greater distance and time. So a woman may donate her eggs and another woman might receive those eggs maybe 10 years later. You get a very different dynamic in terms of what egg donation is and to what extent women get to know each other and how they chose an egg donor, for example. As an ova bank we want to offer our services in countries around the world provided it's legal there.
In Arab countries, for example, it's still illegal. Germany is one of the countries in Europe where the situation is unclear. While sperm donation is permitted there, egg cell donation is prohibited — although that's set to change. If they were to amend the law tomorrow and make egg cell donation legal, we would definitely open an Ovobank there.
In 10 years, we'll be operating in every country where egg cell donation is possible. These containers are special. They contain patented electronics, which we use to track the egg cells once they've been shipped out. Our partners can do the same with the help of an app. Take this shipment, they can see the conditions: like the atmospheric pressure and the humidity. And this is interesting, too: the container's GPS location.
We export a very large number of egg cells. So you're spreading Spanish genes across the world? Sure, that's the plan! Every newborn baby will play the guitar and sing Flamenco! But seriously: it makes us really proud that these patients have been able to become parents with a little help from us. Many people feel that fertility is not a huge, pressing problem. Because for last 30 years we’ve talked about and have been worried about overpopulation: limit the number of babies people should be having! But the reality of the new world is that populations are shrinking.
Women are having fewer babies and they are having babies later. So the populations of Italy are shrinking. The population of the UK will level out very soon. Even China that country that has been so worried about overpopulation and brought in legislation to control how many children you could have China have realised they got a big problem in the future.
Their population will be levelling before the end of the century. So China is now the world’s centre of fertility treatment. People may be surprised to hear that there are more IVF centres in China than in any other country in the world. And this is something we all need to be aware of: that actually it makes economic sense for us to replenish the population that are going to become tax payers and are going to look after all of us in our old age, and pay our pensions. And governments are becoming aware of this. So where does this lead governments, Lucy, when it comes to encouraging women to have children? Yes, I think that’s a very important question.
Because we need to think about fertility as not only a biological and individual issue, but it is also a social and a political issue. We see for example that egg freezing is sometimes offered by governments to try to increase the birth rate. So certain areas in Japan, for example, have paid for women to freeze their eggs in the hope that they will then have more children. In other areas IVF is promoted as a way of increasing the birth rate. And sometimes this is coupled to a nationalist or an anti-immigrant rhetoric. We see this for example in Hungary, where Victor Orban has taken fertility clinics under government control and is offering IVF under the rubric of “we don’t want immigration, we want procreation”.
So we see that fertility and IVF is politized in many different ways. Once I was invited by the king of Spain and he asked me: What do you think the biggest problem of Spain is? And he thought I was going to say the independence movement, youth unemployment and I said: This country is not having babies, and you are not going to have a kingdom. There is not going to be people in your kingdom. There is not going to be people in Spain.
And indeed, the only reason there are people in Spain is thanks to immigrants. And mass immigration — by the way, I am obviously for immigration, I am an immigrant everywhere, I am an immigrant in the US and an immigrant in Spain, and I speak as an immigrant — but having said this, I don’t think the solution to a country can be to have your native population disappear and only have immigrants. I mean, the solution has to be some combination of more babies and immigrants. The only institutions that have decided to pay for egg-freezing are the state of Israel and Apple, Facebook, Microsoft, Google the largest US corporates, they also pay for eggs freezing. So, I think it is quite interesting that the large corporates and Israel came to the same conclusion: that it was a good thing for women to decide when to have a baby, but nobody else did. We shouldn’t lose sight of the causes of the fertility issue.
It is lifestyle to some extent. It’s also very much environmental too. We live in a toxic world. We can’t avoid the problems that the air we breathe and the food we eat are having generally oestrogenic-competing compounds, we call them endocrine-bending compounds, endocrine-changing compounds.
They are affecting our fertility, they are affecting men’s sperm counts, they are affecting the toxicity around the fluid around women’s eggs. So we do live in a world where you combine the age in which a woman wants to start to have a child with a toxic world. And that’s one of the big reasons why our fertility is going down.
How’re you feeling? Good. We've found 14 egg cells, which is a great yield. Good news, right? Yes, that was my main worry.
Understandably! Yay! 14 eggs! 14?! Yes! It's weird, saying that I'm thrilled to have produced 14 eggs. I feel like a chicken. Congratulations.
Thank you! I guess That's a great result for someone of your age. Some women only manage one or two eggs So you've done very well. I'm 26 forever! 26 plus, yes. So am I.
Yeah — 14!