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26 November 2010
Mr Right hasn’t come along and the bio clock is ticking? Don’t fret, freeze. A new, improved technique of putting eggs on ice lets women delay motherhood
Amrita Singh is 35, single, and would like nothing more than to have children of her own. Unfortunately, there’s no man in sight as yet and she’s at an age when female fertility is on the decline. But that hasn’t discouraged Singh, who put plan B into action a few months ago. She got her eggs frozen. "I’m happy I have an investment for myself," the Mumbai girl said. "In case I don’t marry and have trouble conceiving, I can have children using in vitro fertilisation."
Women like Singh are gradually warming up to the idea of preserving their eggs in order to have children late. And, quite understandably, it’s a sensitive subject given the enormous social pressures of early marriage and children that the average Indian woman faces.
No wonder Singh, whose name has been changed, preferred to call TOI–Crest from a public phone booth in order to remain completely anonymous.
Egg or oocyte freezing is not a new practice, it’s just that the technology has been updated. Traditionally, eggs were preserved using a method known as slow freezing, by which they were frozen in an anti–freeze substance called cryoprotectant.
However, while sperms and embryos could successfully be preserved using this method, eggs didn’t fare too well. This is because the egg, the largest cell in the human body, is full of water that turns into damaging ice crystals. The rate of births using slow freezing is abysmally low–two births per 100 eggs preserved.
The newer method, vitrification, has yielded far better results. It involves freezing eggs in higher concentrations of cryoprotectant and cooling them rapidly. In just a few minutes, the eggs must be plunged from the normal body temperature of 37 degrees Celsius to minus 196 degrees in barrels of liquid nitrogen.
"The eggs can be kept in frozen suspension for years, like Sleeping Beauty," infertility specialist Dr Aniruddha Malpani said, "till their owner decides to have a child." In that case, they are thawed and fertilised in vitro. According to Dr Hrishikesh Pai, who practises at Lilavati Hospital, vitrification offers a success rate of 40 per cent.
The technology has been in India for the past few years but only a handful of women have made use of it. One of the reasons could be the cost, which at around Rs 1.5 lakh is prohibitive. Women take recourse to it if they want children late or if they’re suffering from diseases whose treatment might reduce their fertility.
Many women who have opted to freeze their eggs have done so for what doctors term "social reasons". Most of them are in their late 30s and unmarried. "Quite a few women are career oriented," Pai explained.
"They don’t have time to find the right man, but they want to have a child from their own DNA. And technology has made it possible for them to fulfil their wish, even if they want to wait for 10 years. In fact, you can have a child after menopause too."
Infertility specialist Dr Nandita Palshetkar, who practises at Lilavati and Fortis La Femme in Delhi, said she has met women over 40 who want to freeze their eggs. But she suggests they use donor eggs as they’re too old to produce eggs of good quality.
The oldest patient she has treated is a 38–year–old. Malpani believes that "it’s an empowering technology" and expects it to catch on in the future. Over the two years he has been practicing oocyte freezing, he has frozen the eggs of three women. "This is a back–up plan," he said.
"If she meets the man of her dreams and has a baby, then great. Otherwise she could use donor sperm."
At one time, women found the idea of using donor sperm distasteful. While the practice is still not widespread, single women are gradually beginning to consider it. "Most single women are not averse to getting their eggs fertilized by donor sperms," Palshetkar said.
Ten years ago, 51–year–old businesswoman Anita Thomas didn’t act on her doctor’s suggestion that she freeze her eggs, balking at the prospect of having them fertilised by donor sperm. Thomas, who is still unmarried, doesn’t think she would have been brave enough to be a single mother, but the ‘what if ’ thought does cross her mind.
Singh isn’t entirely comfortable with the idea either, but remains undecided. "I believe in marriage," she explained. "But I want a child for sure. And it’s not impossible to be a single mother. You read about people like Sushmita Sen."
Only a few hospitals and infertility clinics practice this technique so far. But this could soon change. Cryos, the country’s first international sperm bank, is planning to start egg freezing soon.
Managing director Dilip Patil said sperm banks are under pressure from the Indian Council for Medical Research (ICMR) to acquire the technology, as a bill that seeks to regulate assisted reproductive technology (ART), proposed by the health ministry, requires semen banks to provide oocytes as well.
If the technology becomes more easily available, it would also benefit women suffering from serious illnesses such as cancer. Treatments like radiation and chemotherapy can affect a woman’s fertility, ruining her chances of conceiving after she is cured.
Such patients also have another shot at pregnancy, but one that’s far more daunting than egg freezing – ovarian tissue preservation. This is a complex procedure that involves removing the ovaries, carving its cortex into strips and freezing these in cryoprotectant.
When the woman is ready to have a child, the strips are thawed, divested of follicles, which can then be matured and fertilized in vitro. Pai has till date performed this technique only on two women. "It’s a very tedious process," he explained. "Women are psyched. They prefer to borrow eggs from outside."
That such technology is now available in India is good news for cancer patients. The country has a large population of young cancer patients, of which a sizeable number are women who suffer from breast cancer.
Shubha Maudgal, director of NGO Cancer Patients Aid Association, said that while in the West the average age of cancer patients is 50, in India it is closer to 40 years. She has had to deal with several breast cancer patients in their late 20s who overlooked family planning in their hurry to get cured. "The rush is to get the tumour out," Maudgal said.
"They’re not thinking about having children. Doctors also tend to focus on the tumour and not the person around the tumour."
She hopes that an increased interest in egg freezing and ovarian tissue preservation will make the technology more widespread and affordable. "There is life after breast cancer," she said. "So these are things we have to look into."
(Some names have been changed)