tag:theconversation.com,2011:/us/topics/egg-freezing-26743/articlesegg freezing – The Conversation2023-11-28T16:52:45Ztag:theconversation.com,2011:article/2177262023-11-28T16:52:45Z2023-11-28T16:52:45ZWhy you should talk about fertility, even if you don’t want children – and what you should discuss<figure><img src="https://images.theconversation.com/files/561557/original/file-20231124-23-k697g6.jpg?ixlib=rb-1.1.0&rect=0%2C152%2C7551%2C4975&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/diverse-male-female-hipsters-having-positive-1746193439">GaudiLab/Shutterstock</a></span></figcaption></figure><p>Women (and men) are having their first child at older ages. As a result, couples are sometimes unable to conceive or require medical intervention in their pursuit of parenthood. Others may face a <a href="https://ifstudies.org/blog/the-global-fertility-gap#:%7E:text=While%20fertility%20ideals%20around%20the,children%20is%20a%20serious%20problem">“fertility gap”</a> between the number of children they anticipate having and those they actually have.</p>
<p>Young people often <a href="https://www.tandfonline.com/doi/abs/10.1080/14647273.2020.1798516">overestimate</a> womens’ capacity to become pregnant as they age, and the extent to which technology like IVF can help them conceive.</p>
<p>Despite these issues, conversations about fertility and childbearing remain taboo. <a href="https://www.emerald.com/insight/publication/doi/10.1108/9781787564831">I have found</a> that women in particular feel uncomfortable bringing it up in new relationships, fearing that discussing a desire for motherhood may “put off” potential romantic partners or make them appear “desperate” for a baby.</p>
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<p><em><a href="https://theconversation.com/uk/topics/should-i-have-children-148388?utm_source=TCUK&utm_medium=InArticleTop&utm_campaign=Parenting2023">Should I have children?</a> The pieces in this series will help you answer this tough question – exploring fertility, climate change, the cost of living and social pressure.</em></p>
<p><em>We’ll keep the discussion going at a live event in London on November 30. <a href="https://www.waterstones.com/events/the-conversation-should-i-have-children/london-tottenham-court-road">Click here</a> for more information and tickets.</em></p>
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<p>But these conversations can be crucial in preventing future relationship breakdown, and preparing for age-related fertility decline. No matter your situation – single, coupled-up, or childfree by choice – you might benefit from talking earlier and more often about your plans. </p>
<p>Here’s what to talk about depending on your situation.</p>
<h2>I want to have a child, but not yet</h2>
<p>Many factors are leading women and couples to delay having children. Women are participating more in the labour force, there are more reliable forms of contraception available, and it’s more accepted to have multiple relationships before getting married or having a child.</p>
<p>The growing gap between wages and the cost of living means it is harder to achieve the <a href="https://theconversation.com/more-young-people-in-the-uk-are-living-with-parents-and-grandparents-heres-what-you-need-to-know-if-youre-considering-it-216280">standard of living</a> that many deem necessary to become parents. </p>
<p>Whatever the reason, technology like egg or embryo freezing may offer the opportunity to preserve reproductive material for future use. </p>
<p>Egg freezing sees women undergo the same ovarian stimulation and retrieval process as IVF patients. A number of her eggs are then frozen and stored for future use. Used most often by women who do not yet have a partner, egg freezing <a href="https://theconversation.com/six-things-you-should-know-if-you-are-considering-freezing-your-eggs-94039">at any age</a> cannot guarantee a live birth. </p>
<p>Previously, the law only permitted eggs to be frozen for up to 10 years. This meant a woman who froze her eggs at 30 would have to use them by the time she was 40 or risk them being destroyed. A <a href="https://www.legislation.gov.uk/ukpga/2022/31/schedule/17/enacted">legal change</a> in 2021 means women in England and Wales are now able to freeze their eggs for up to 55 years, making this a more viable form of “fertility extension”.</p>
<p>The <a href="https://www.londoneggbank.com/news/blog/what-is-the-best-age-to-freeze-my-eggs/#:%7E:text=Indeed%2C%20more%20than%20any%20other,smaller%20number%20over%20age%2035.">optimum time</a> to undertake egg freezing is before the steepest decline in a woman’s fertility in her late 30s. The best results are generally from women who froze their eggs by the time they were 35.</p>
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<img alt="Close up of a woman looking solemnly at a pregnancy test" src="https://images.theconversation.com/files/561561/original/file-20231124-29-fzrvr1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/561561/original/file-20231124-29-fzrvr1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/561561/original/file-20231124-29-fzrvr1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/561561/original/file-20231124-29-fzrvr1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/561561/original/file-20231124-29-fzrvr1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/561561/original/file-20231124-29-fzrvr1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/561561/original/file-20231124-29-fzrvr1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">People are delaying pregnancy for a number of health and social reasons.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-pregnancy-test-hands-427218448">Pressmaster/Shutterstock</a></span>
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<p>Embryo freezing – where eggs are fertilised and stored for later use – offers a greater chance of a live birth and can be achieved as part of a relationship, or with donor sperm. </p>
<p>Embryos created by a couple can lead to complications if the relationship breaks down. One party may want the genetic material destroyed against the other’s wishes. Embryo freezing may be an option for stable couples who need to delay parenthood due to issues like illness or overseas deployments. However, it is unlikely to be of use to those who aren’t ready to have a child due to the cost of living or who are trying to save for their first home. The cost of the procedure, like egg freezing, can often be between £3,000-£4,000 or more, plus annual storage fees. </p>
<h2>I’m not sure, and I’m getting older</h2>
<p>Fertility monitoring can provide some insights into reproductive health for both <a href="https://www.createfertility.co.uk/blog/whats-a-fertility-mot-and-why-are-experts-recommending-it-to-women#:%7E:text=What%20does%20a%20Fertility%20MOT,time%20in%20the%20menstrual%20cycle.">women</a> and <a href="https://www.londonivfandgenetics.co.uk/fertility-mot/male-mot/">men</a>.</p>
<p>Fertility “MOTs” are offered by clinics and as <a href="https://hertilityhealth.com/?tw_source=google&tw_adid=681259505447&tw_campaign=19778466649&gad_source=1&gclid=CjwKCAiAjfyqBhAsEiwA-UdzJP0C3Wl-suGdFy73atjNWo656QCKLzylw2_zjbzOmRqIosPmubgjaRoCBSsQAvD_BwE">at-home tests</a>. They can reveal sperm quantity and motility, give an indication of ovarian reserve and help identify factors which could inhibit conception. </p>
<p>However they cannot reliably be used to calculate how many “fertile years” a woman has, or provide detailed quantitative insights in to a woman’s ovarian reserve. They are also not provided on the NHS and clinics often charge in excess of £500 for such tests.</p>
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Read more:
<a href="https://theconversation.com/at-home-fertility-tests-heres-what-they-can-actually-tell-you-198639">At-home fertility tests: here's what they can actually tell you</a>
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<p>Like those in heterosexual relationships, LGBTQ+ couples can also access technologies like egg or embryo freezing through the use of donated gametes (egg and sperm) and can build their families with the help of a <a href="//www.sciencedirect.com/science/article/pii/S1472648313001806">surrogate</a>. Like most fertility treatment, these procedures are rarely fully funded by the NHS and can cost tens of thousands of pounds. </p>
<h2>I don’t want children – but what if I change my mind?</h2>
<p>Without question, technology has created more opportunities for people to have children later in life, even if they just want to keep their options open. But egg freezing and fertility monitoring have financial, physical and emotional costs, and are not a guarantee. </p>
<p>For many, the best form of preparation is a conversation. </p>
<p>If you are a young woman unsure about having children, this may mean speaking to immediate female family members about the age they experienced menopause and any fertility issues within the family. Even if you are not planning to have children, these conversations can be helpful for learning about other medical issues that may affect you in ways beyond fertility, such as endometriosis or PCOS.</p>
<p>Evidence has <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3717046/">also shown</a> that both women and men can improve their fertility chances by paying attention to issues such as their weight, stress levels, alcohol consumption and exercise patterns. These are all things that can benefit general health, regardless of your plans for children.</p>
<p>Talking more openly about fertility and the choice to have children or not can help break the stigma around these topics. Just as people (women especially) may face criticism for <a href="https://theconversation.com/women-still-face-unfair-pressure-about-having-children-heres-what-to-expect-if-you-dont-have-kids-when-youre-young-217135">delaying parenthood</a>, there are social taboos around deciding not to have children. The conversations you have now may help you, and future generations, make more informed decisions about their reproductive choices.</p><img src="https://counter.theconversation.com/content/217726/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kylie Baldwin receives funding from The Foundation for Sociology of Health and Illness</span></em></p>Talking about plans for childbearing is still seen as a taboo.Kylie Baldwin, Senior Lecturer, De Montfort UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1899782022-11-30T00:55:27Z2022-11-30T00:55:27ZWomen are often told their fertility ‘falls off a cliff’ at 35, but is that right?<figure><img src="https://images.theconversation.com/files/488678/original/file-20221007-22-3zo9sd.jpg?ixlib=rb-1.1.0&rect=0%2C5%2C3988%2C2646&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>It’s a fact women’s fertility declines as they age. But the common description of fertility decline after age 35 as a “cliff” is more anxiety-provoking than factual.</p>
<p>If you want children, it’s important to understand the biology of fertility. This can help those who have a choice about timing to decide when to start trying for a baby. </p>
<p>And for those who don’t have a choice about timing, knowing what the options are can help make the best possible decisions.</p>
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<h2>Female ageing, egg numbers and quality</h2>
<p>A baby girl is born with about one million eggs in her tiny ovaries, but by the time she reaches puberty there are only about 300,000 eggs left. This is a normal physiological process called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429023/">atresia</a>.</p>
<p>Of the eggs that remain when a woman starts having periods, only 300-400 will mature and be released in ovulation during the reproductive years. By the time a woman reaches menopause, there are no more functioning eggs in her ovaries. </p>
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<a href="https://images.theconversation.com/files/488703/original/file-20221007-20453-v8svu9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Newborn baby being held by a nurse" src="https://images.theconversation.com/files/488703/original/file-20221007-20453-v8svu9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488703/original/file-20221007-20453-v8svu9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488703/original/file-20221007-20453-v8svu9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488703/original/file-20221007-20453-v8svu9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488703/original/file-20221007-20453-v8svu9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488703/original/file-20221007-20453-v8svu9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488703/original/file-20221007-20453-v8svu9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">When a baby girl is born, she has about a million eggs in her ovaries.</span>
<span class="attribution"><span class="source">Christian Bowen/Unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>While women in their mid- to late forties sometimes have “miracle babies”, the <a href="https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/age-and-fertility/">chance of pregnancy is minimal</a> in the five to ten years leading up to menopause.</p>
<p>As women age, egg quality declines too. It’s estimated about 20% of all human eggs are “aneuploid”, which means they have the wrong number of chromosomes. This <a href="https://academic.oup.com/humupd/article/14/2/143/609857">proportion increases as women age</a>.</p>
<p>When an aneuploid egg is fertilised by a sperm it gives rise to an aneuploid embryo – which in most cases stops developing or ends in an <a href="https://www.sciencedirect.com/science/article/abs/pii/S1383574220300405?via%3Dihub">early miscarriage</a>.</p>
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<em>
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Read more:
<a href="https://theconversation.com/mens-fertility-also-declines-with-age-heres-what-to-know-if-youre-planning-to-wait-to-have-kids-187498">Men’s fertility also declines with age — here’s what to know if you’re planning to wait to have kids</a>
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<h2>What does this mean for the chance of a baby at different ages?</h2>
<p>A woman’s most fertile years are between her late teens and late 20s. By around age 30, fertility starts to slowly decline and by mid-30s the decline speeds up. </p>
<p>But the decrease in chance of pregnancy after age 35 is gradual and more like a slope than a cliff, at least until age 40.</p>
<p>A <a href="https://www.fertstert.org/article/S0015-0282(16)00152-7/fulltext">large study</a> that followed women trying for a baby found the chance of pregnancy after 12 months was 87% for women aged 30-31. This dropped to 76% at age 36-37, and 54% at age 40-41. </p>
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<iframe src="https://flo.uri.sh/visualisation/11766699/embed" title="Interactive or visual content" class="flourish-embed-iframe" frameborder="0" scrolling="no" style="width:100%;height:600px;" sandbox="allow-same-origin allow-forms allow-scripts allow-downloads allow-popups allow-popups-to-escape-sandbox allow-top-navigation-by-user-activation" width="100%" height="400"></iframe>
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<p>So up to age 41, most women who try for a baby will be pregnant after trying for up to 12 months. But the proportion who don’t achieve pregnancy increases with age, and the drop in chance is more noticeable after age 35.</p>
<p>Unfortunately, because the number of chromosomally abnormal (aneuploid) eggs increase with age, the risk of miscarriage increases as women age. For women in their early to mid-30s the <a href="https://www.bmj.com/content/364/bmj.l869">risk of miscarriage</a> is about one in ten. This increases to about one in three for women aged 40-44 years. </p>
<h2>What about men’s age and fertility?</h2>
<p>While it happens later in life than for women, <a href="https://rbej.biomedcentral.com/articles/10.1186/s12958-015-0028-x">men’s age</a> affects the chance of pregnancy too. Sperm quality and fertility <a href="https://www.fertstert.org/article/S0015-0282(03)00366-2/fulltext">decline around age 45</a> and pregnancies fathered by men aged 45 or older are almost <a href="https://academic.oup.com/humupd/article/26/5/650/5827629">50% more likely to miscarry</a> than pregnancies fathered by men aged 25-29. </p>
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<span class="caption">Many men don’t realise their fertility declines with age too.</span>
<span class="attribution"><span class="source">Pexels/Nathan Cowley</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>IVF is not a good plan B</h2>
<p>Unfortunately, IVF can’t improve the quality of eggs, and the woman’s age is the biggest determinant of IVF success. <a href="https://www.varta.org.au/resources/news-and-blogs/how-likely-are-you-have-baby-after-one-two-or-three-ivf-cycles">Data from Victoria</a> show that after three completed IVF cycles, 61% of women aged 34-35 when they started treatment had a baby. </p>
<p>The chance of a baby after three cycles at age 36-37 was 50% and at age 38-39 it was 38%. But by age 40-41 only 25% of women had a baby after three IVF cycles. </p>
<p>The chance of IVF success is also affected by the male partner’s age. <a href="https://doi.org/10.1016/j.fertnstert.2021.03.033">Studies</a> show that live-birth rates are lower in couples where the male partner is aged 45 or older than in couples where the male partner is younger than this. </p>
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<em>
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Read more:
<a href="https://theconversation.com/thinking-about-freezing-your-eggs-to-have-a-baby-later-here-are-3-numbers-to-help-you-decide-187845">Thinking about freezing your eggs to have a baby later? Here are 3 numbers to help you decide</a>
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<h2>What are the options?</h2>
<p>Life circumstances, including not finding a partner who is willing to commit to parenthood, can prevent people from having children during their most fertile years. </p>
<p>Here are some options if you are worried about how age might affect your chance of having a baby: </p>
<ul>
<li><p>going it alone: if you are single, you can consider joining the <a href="https://www.smcaustralia.org.au/">growing group of women</a> who use donor sperm to become “solo mums by choice”. The <a href="https://www.varta.org.au/resources/news-and-blogs/media-release-victorians-warned-about-risks-informal-sperm-donation">safest option</a> for you and your baby is to find a donor through a fertility clinic.</p></li>
<li><p>freezing eggs for later: while this might seem an attractive option, it’s costly and there is no guarantee of a baby down the track. To help you decide if this is the right option for you, <a href="https://theconversation.com/thinking-about-freezing-your-eggs-to-have-a-baby-later-here-are-3-numbers-to-help-you-decide-187845">here are some facts</a> about egg freezing.</p></li>
<li><p>having IVF: if you are 35 years or older and have been trying for a baby for six months or more, see your GP for advice and basic fertility tests. Depending on test results, your GP can refer you to a fertility specialist. If you need IVF, sooner is better than later because age affects the chance of IVF success.</p></li>
<li><p>using donor eggs: the chance of a baby with IVF is negligible after age 40 unless you use eggs donated by a younger woman. <a href="https://doi.org/10.1111/ajo.13179">Studies show</a> after age 40, women using donor eggs are five times more likely to have a baby than women using their own eggs. </p></li>
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<p>Finally, a word of caution. <a href="https://bmjopen.bmj.com/content/11/7/e046927">Ovarian reserve testing</a> is often promoted as a way for women to find out their fertility and chance of getting pregnant.</p>
<p>The so called “egg timer” test measures the level of anti-mullerian hormone (AMH) in the blood, a hormone produced by reproductive tissues. The thinking is the more eggs present, the more AMH will be present, so it’s marketed as a type of “egg counting”.</p>
<p>However, <a href="https://jamanetwork.com/journals/jama/fullarticle/2656811">research shows</a> the test is not a reliable test of a woman’s fertility. On average, women of the same age have the same monthly chance of getting pregnant, regardless of their AMH level.</p>
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Read more:
<a href="https://theconversation.com/womens-fertility-does-egg-timer-testing-work-and-what-are-the-other-options-109726">Women's fertility: does 'egg timer' testing work, and what are the other options?</a>
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<p class="fine-print"><em><span>Karin Hammarberg works for the Victorian Assisted Reproductive Treatment Authority</span></em></p>Women’s fertility declines with age, but the ‘cliff’ we often hear about at age 35 is a myth: it’s more of a gentle slope.Karin Hammarberg, Senior Research Fellow, Global and Women's Health, School of Public Health & Preventive Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1905312022-10-30T23:27:00Z2022-10-30T23:27:00ZStarting cancer treatment? You should discuss fertility first<figure><img src="https://images.theconversation.com/files/490573/original/file-20221019-20-rhatnq.jpg?ixlib=rb-1.1.0&rect=43%2C25%2C5708%2C3802&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/organic-baby-clothes-600w-261828743.jpg">Shutterstock</a></span></figcaption></figure><p>Not all Australians with cancer are getting the fertility care they need.</p>
<p>In 2022, it is predicted more than 8,200 Australians under 40 – in their reproductive years – will be <a href="https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/cancer-survival-by-age-visualisation">diagnosed with cancer</a>. This is more than double the rate in the 1980s. </p>
<p>The good news is more men, women and children than ever are surviving cancer. This is due to earlier diagnosis and more successful cancer treatments. Now <a href="https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/cancer-survival-by-age-visualisation">over 85%</a> of patients under 40 will still be alive five years after their cancer diagnosis. </p>
<p>However, many of them might not be aware of the potential decrease in fertility after cancer treatments, and their options for protecting their future ability to have children. Some estimates suggest <a href="https://academic.oup.com/humupd/article/25/2/159/5193422">only half</a> of people with cancer have a documented fertility preservation discussion.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1573592063051972611"}"></div></p>
<h2>How cancer treatment can affect fertility</h2>
<p>Both cancer and its treatments can reduce fertility for all genders.</p>
<p>Chemotherapy, radiation and surgery may <a href="https://www.fertstert.org/article/S0015-0282(18)30435-7/fulltext">permanently reduce</a> the number of egg and sperm cells, which may lead to difficulty conceiving in the future.</p>
<p>The store of eggs is laid down before birth, and to date there is no good evidence eggs can be replenished. Chemotherapy – chemical drug treatments that attack cancer cells – may also harm the delicate egg and sperm cells and reduce their numbers. </p>
<p>Likewise, radiotherapy – directed radiation energy at cancer cells – may scatter and cause scarring of the ovaries and testicular tissue. </p>
<p>Sometimes, with high-dose chemotherapy or radiotherapy, all the eggs, sperm cells and supporting tissues may be destroyed. Direct surgery to reproductive organs may lead to reduced fertility.</p>
<p>Often, it is not known what the full effect of cancer treatment will be on fertility, and the effect may be different for each individual.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/problems-conceiving-are-not-just-about-women-male-infertility-is-behind-1-in-3-ivf-cycles-192183">Problems conceiving are not just about women. Male infertility is behind 1 in 3 IVF cycles</a>
</strong>
</em>
</p>
<hr>
<h2>What is oncofertility, and how can it help?</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4710491/">Oncofertility</a> is a relatively recently established medical field that provides options for fertility preservation. Addressing quality of life from a biological, psychological and social perspective acknowledges the potential distress that reduced fertility might cause cancer survivors.</p>
<p>Advances in assisted reproductive technology, such as <a href="https://pubmed.ncbi.nlm.nih.gov/25428012/">vitrification</a> (fast freezing), means we can preserve eggs, embryos, ovarian tissue, sperm and testicular tissue for future use. This is known as medical fertility preservation. </p>
<p>Fertility preservation may be someone’s best chance for biological children in the future. Oncofertility considers an individual’s future goals for family and parenthood, alongside cancer treatments. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/5-things-not-to-say-to-someone-struggling-with-infertility-138510">5 things not to say to someone struggling with infertility</a>
</strong>
</em>
</p>
<hr>
<h2>4 new things we know about oncofertility</h2>
<p>This year, the <a href="https://www.cancer.org.au/clinical-guidelines/cancer-fertility-preservation">Clinical Oncology Society of Australia</a> (COSA) updated its guidelines for fertility preservation for people with cancer. </p>
<p>It is based on advice from Australian experts including medical specialists, scientific researchers, psychologists, health managers and nurses, public consultation and feedback. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1544477144604090370"}"></div></p>
<p>The COSA guidelines discuss fertility treatment options, referral pathways and psychological support. They also cover contraception during cancer treatment (to avoid disruption to the treatment regimen), interrupting hormone treatment to conceive, assisted reproduction, and the risk of cancer recurrence. This guideline aims to support conception and pregnancy in cancer survivors. </p>
<p>In our paper published today in the <a href="https://www.mja.com.au/journal/2022/217/11/australian-fertility-preservation-guidelines-people-cancer-2022-review-and">Medical Journal of Australia</a> we update medical practitioners on the latest in oncofertility knowledge: </p>
<ol>
<li><p>that pregnancy rates after freezing eggs are similar to those after freezing embryos, with live birth rates of 46% and 54% respectively in <a href="https://obgyn.onlinelibrary.wiley.com/doi/10.1111/aogs.13559">one study</a> </p></li>
<li><p>ovarian tissue <a href="https://www.mivf.com.au/sites/mivf/files/2020-10/Preserving%20your%20fertility%20-%20About%20ovarian%20tissue%20freezing.pdf">freezing</a> and grafting for females is no longer considered “experimental”, however special oversight for pre-pubertal girls under the age of 13 years is recommended. This is because clinical experience of patients who were 20 years of age or younger at the time of fertility preservation <a href="https://pubmed.ncbi.nlm.nih.gov/30773394/">remains limited</a> </p></li>
<li><p>extracting sperm from testicular tissue by <a href="https://link.springer.com/article/10.1007/s10147-016-0998-5">microsurgery</a> may be considered for men who have already undergone cancer treatment and who were <a href="https://ascopubs.org/doi/full/10.1200/JCO.2010.33.7808">previously thought to have no sperm</a> </p></li>
<li><p>testicular tissue freezing in pre-pubertal boys is currently considered “<a href="https://onlinelibrary.wiley.com/doi/10.1111/cen.13377">experimental</a>” as there are no mature sperm cells. Clinical ethical oversight is required while new methods are trialled to use these early cells for fertility. </p></li>
</ol>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/GFgneVTs_Og?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Health professionals can support newly diagnosed patients through their oncofertility journey.</span></figcaption>
</figure>
<h2>Timing is important</h2>
<p>Once a diagnosis of cancer is made, discussion and decisions around fertility can be urgent and time-critical. </p>
<p>This is to allow time for referral to an oncofertility unit, appropriate counselling and informed decision-making to occur. </p>
<p>It takes time to plan and perform fertility preservation (for example, eggs may take around 14 days to grow and collect for freezing) so promptness is important to prevent delays in cancer treatment. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/researchers-have-grown-human-embryos-from-skin-cells-what-does-that-mean-and-is-it-ethical-157228">Researchers have grown 'human embryos' from skin cells. What does that mean, and is it ethical?</a>
</strong>
</em>
</p>
<hr>
<h2>Educating patients</h2>
<p>Not everyone of child-producing age who is diagnosed with cancer is referred to oncofertility health services promptly, if at all. This can lead to feelings of <a href="https://www.cancer.org.au/clinical-guidelines/cancer-fertility-preservation/referral-and-service-provision/Referral-rates-and-decisional-conflict">conflict and regret</a>. </p>
<p>Our team of fertility specialists from the <a href="https://www.thewomens.org.au/patients-visitors/clinics-and-services/fertility-genetics/fertility-preservation/">Royal Women’s</a> and <a href="https://www.rch.org.au/fertility/">Royal Children’s</a> Hospitals collaborated with the <a href="https://www.vics.org.au/wcmics-about-us">Western and Central Melbourne Integrated Cancer Service</a> to develop a suite of animated patient education videos to address this gap. </p>
<p>The <a href="http://www.fertilityaftercancer.org/">Fertility after Cancer</a> videos – available in multiple languages, reviewed by cancer patients and support groups, age-appropriate for children, adolescents, adults, and their families — discuss fertility preservation options, risks, benefits and alternatives.</p>
<p>Our goal is that all Australians with cancer have access to information, and support, regarding the impact of cancer treatments on their future fertility.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/AB2LExT4qo4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A quick guide to oncofertility choices.</span></figcaption>
</figure><img src="https://counter.theconversation.com/content/190531/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Violet Kieu is a Fertility Specialist at The Royal Women's Hospital and Melbourne IVF. To attend scientific conferences, she has received support from Merck, Gedeon Richter, and honorarium from Organon. In conjunction with the Western and Central Melbourne Integrated Cancer Service, Violet co-created the <a href="http://www.fertilityaftercancer.org">www.fertilityaftercancer.org</a> patient education videos.</span></em></p><p class="fine-print"><em><span>Kate Stern is a fertility specialist and head of the Fertility Preservation Service (FPS) at the Royal Women's Hospital and Melbourne IVF. These organisations both provide fertility preservation treatment for cancer patients. Kate is a board member of Fertility Matters, a not-for-profit organisation which develops fertility education tools for schools. The FPS has previously received non-directed grants for research from Merck-Serono and MSD. Kate is also a member of the Future Fertility Registry group which has developed a national and international database for fertility preservation patients. Previously this registry has received administrative support from Merck-Serono. Kate established the NOTTCS tissue transport program for young cancer patients and this receives support from Sony Foundation.</span></em></p>Both cancer and cancer treatment can impact someone’s ability to have biological children. It’s important to discuss fertility right after cancer diagnosis.Violet Kieu, Clinical Senior Lecturer, Department of Obstetrics & Gynaecology, The University of MelbourneKate Stern, Associate Professor,, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1694192021-11-03T19:22:42Z2021-11-03T19:22:42ZNot all women who freeze their eggs want to have children<p>Since the development of ultra-rapid egg freezing <a href="https://pubmed.ncbi.nlm.nih.gov/23083924/">around 2013</a>, more and more women worldwide are choosing to undergo the procedure. <a href="https://www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2018-trends-and-figures/">In the UK</a>, egg freezing has increased by 240% in recent years, from 569 completed cycles in 2013 to 1,933 in 2018. In France, according to my research, around 2,500 women freeze their eggs each year.</p>
<p>Egg freezing gained increased international popularity in 2014, when <a href="https://www.theguardian.com/technology/2014/oct/15/apple-facebook-offer-freeze-eggs-female-employees">Apple and Facebook announced</a> they would cover the procedure for female employees who wanted it. The aim at the time was to allow women to balance motherhood with working life.</p>
<p>Such associations lead to a “careerist” image of women who freeze their eggs in the name of the working life. But most of the research published to date indicates that it is the <a href="https://pubmed.ncbi.nlm.nih.gov/30074130/">absence of a partner</a> rather than the pursuit of education or a career that is the main motivation for egg freezing.</p>
<p>Other <a href="https://dora.dmu.ac.uk/bitstream/handle/2086/13109/Baldwin%20%282016%29%20Ice%2c%20Ice%2c%20Baby%20A%20Sociological%20Exploration%20of%20Social%20Egg%20Freezing%20PhD%20Thesis.pdf">studies</a> on the topic suggest that women who freeze their eggs have a strong desire for children. But not all <a href="https://pubmed.ncbi.nlm.nih.gov/28077428/">women who have children after egg freezing</a> do so with their frozen ova. Indeed, the return rate is <a href="https://pubmed.ncbi.nlm.nih.gov/26688429/">less than 10%</a>.</p>
<p>This raises the question: why do women freeze their eggs, if not to use them later? My <a href="http://www.theses.fr/2021EHES0049">doctoral research</a> in social anthropology and ethnology examined this question.</p>
<h2>The borderline between motherhood and childfree</h2>
<p>I conducted 43 interviews with French women who had frozen their eggs for age-related or medical reasons, or who taken part in egg donation.</p>
<p>Although a majority of the women I spoke to expressed a desire for a child, a third said they felt uncertain about having children, while five said they wanted to remain childfree.</p>
<p>In their testimonies, the women who were unsure or who didn’t want children often placed themselves on the borderline between wanting and not wanting to become mothers. Ilka*, 39, said:</p>
<blockquote>
<p>“I took this step to confront the question of whether I really want children or whether I want them at all costs. So, I don’t fall into the category of ‘I don’t want them at all’ or ‘I want them at all costs’.”</p>
</blockquote>
<p>This was also the case for Rosalinda*, 34, who froze her eggs for medical reasons and also for egg donation:</p>
<blockquote>
<p>“I don’t know if I want a child. Every time I’m asked the question: ‘You don’t want a child now. What about later?’ I don’t want one, full stop. Maybe later, I don’t know.”</p>
</blockquote>
<p>For these women, egg freezing allowed them to confront the question of their “true” desire for a child without losing the possibility of conceiving altogether. Faced with potential infertility associated with ageing, medical treatment or illness, they feared they would no longer be able to give birth, if the desire one day arose. Egg freezing offered them a kind of prolongation of uncertainty until one or other option becomes obvious.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/428237/original/file-20211025-19-txy0yk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A liquid nitrogen bank containing sperm and egg samples" src="https://images.theconversation.com/files/428237/original/file-20211025-19-txy0yk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/428237/original/file-20211025-19-txy0yk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/428237/original/file-20211025-19-txy0yk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/428237/original/file-20211025-19-txy0yk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/428237/original/file-20211025-19-txy0yk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/428237/original/file-20211025-19-txy0yk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/428237/original/file-20211025-19-txy0yk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Freezing eggs allows women to prolong the uncertainty around having children.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/fr/image-photo/liquid-nitrogen-bank-containing-sperm-eggs-348353672">Elena Pavlovich/Shutterstock</a></span>
</figcaption>
</figure>
<p>The decision not to have children is a difficult and <a href="https://www.cairn.info/revue-population-et-societes-2014-2-page-1.htm">socially marginalised</a> one for women to make, both from a social and personal point of view. They are frequently questioned about their choices. In my study, even these the women who said they definitely did not want children expressed the fear of regretting not having had them in future.</p>
<p>Rita*, 35, explained her decision to freeze her eggs this way:</p>
<blockquote>
<p>“I don’t want to have a child. I am 35 years old. I don’t want to. I’ve never wanted to, but I know that you can change. I tell myself that if one day I change my mind, I will have planned for this option.”</p>
</blockquote>
<p>Tania*, 32, had her eggs frozen after being diagnosed with breast cancer. She said:</p>
<blockquote>
<p>“I have evolved in my relationship with the world and have become increasingly firm and radical about what I want. Not only do I not want a child, I don’t particularly want to be in a couple either.”</p>
</blockquote>
<p>Tania talked about egg freezing as a “well-directed choice” at the time. She said she and her doctors considered it to be the right option after her cancer diagnosis, a moment of psychological distress when making a decision about having children in future would have been difficult.</p>
<h2>All doors open</h2>
<p>My research shows that some women undertake an arduous and psychologically costly journey for a purpose that is not necessarily reproductive. Having frozen eggs places these women not in the “childless” group, but in the “not-yet-mothers” group.</p>
<p>Egg freezing seems to leave women with all doors open. It aims to give them a chance of childbearing in the future. It also allows them to make the choice, temporary or permanent, to be childfree without completely losing the possibility of having children later.</p>
<p>The decision to freeze eggs thus offers a temporary medical response to the uncertainty associated with motherhood in the modern age.</p>
<hr>
<p><em>* All names have been changed for privacy reasons.</em></p><img src="https://counter.theconversation.com/content/169419/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yolinliztli Pérez-Hernández has received funding from the Biomedicine Agency (ABM) and the National Council for Science and Technology (CONACyT, Mexico).</span></em></p>Why do women freeze their eggs? My research shows it’s for a range of reasons, and not always due to a desire to become a mother.Yolinliztli Pérez-Hernández, Docteure en Anthropologie sociale et ethnologie, Institut National d'Études Démographiques (INED)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1674202021-09-07T15:01:55Z2021-09-07T15:01:55ZEgg freezing: why extending the ten-year limit won’t mean more older mums<figure><img src="https://images.theconversation.com/files/419802/original/file-20210907-24-14v82zs.jpg?ixlib=rb-1.1.0&rect=11%2C0%2C7928%2C5304&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The limit has been extended from ten years to up to 55 years. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/worker-brown-latex-gloves-takes-material-1470930044">bezikus/ Shutterstock</a></span></figcaption></figure><p>The number of women choosing to freeze their eggs is <a href="https://academic.oup.com/hropen/article/2017/1/hox003/3092404">on the rise</a> in Europe, including in <a href="https://www.bbc.co.uk/news/health-48205986">the UK</a>. Even during the pandemic, fertility clinics have seen a <a href="https://www.bionews.org.uk/page_152631">sharp rise</a> in the number of women enquiring about egg freezing. While there are many reasons why a woman may elect to freeze her eggs, regulations in the UK are extremely restrictive, stipulating that eggs frozen for social reasons can only be stored for up to ten years. Then, a person would have to decide whether to use those eggs or destroy them.</p>
<p>Freezing technology has come a long way since regulations were first made, leading <a href="https://www.bionews.org.uk/page_135507">many experts to argue</a> there’s currently no medical reason to limit storage so restrictively. As a result, the UK government plans to extend the storage limit. This will allow people to be able to store frozen eggs, sperm and embryos for <a href="https://www.theguardian.com/science/2021/sep/06/people-able-to-freeze-embryos-sperm-and-eggs-for-up-to-55-years">up to 55 years</a> regardless of the reason for freezing – giving them more choice when it comes to their fertility.</p>
<p>Already, this has seen concerns that more women will <a href="https://www.dailymail.co.uk/health/article-9961003/Freeze-eggs-55-years-Fertility-revolution-sight-new-law-end-10-year-storage-limit.html">delay motherhood</a> until later in life – even into their 50s and 60s. Based on <a href="https://books.emeraldinsight.com/page/detail/Egg-Freezing-Fertility-and-Reproductive-ChoiceEgg-Freezing,-Fertility-and-Reproductive-Choice/?k=9781787564848">my own research</a> and that of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/soc4.12850">others</a>, many women who freeze their eggs do not want to delay motherhood into their 50s and 60s – and instead wish to have children as soon as they are able to. </p>
<p>It’s also worth noting that many UK fertility clinics will not routinely provide fertility treatment of any kind to a women much beyond the age of 50, whether this is with her own eggs or that of a donor. So these practices would also have to change in order for women to delay motherhood into their 50s. </p>
<p>Instead, the extended limit means more women in many different situations will be able to choose to become a mother at a time that is right for them which most often will be in their late 30s or early to mid 40s. </p>
<h2>Egg freezing</h2>
<p>Since 2013, the number of egg-freezing cycles performed by UK clinics has <a href="https://www.hfea.gov.uk/media/2656/egg-freezing-in-fertility-treatment-trends-and-figures-2010-2016-final.pdf">more than doubled</a> as greater numbers of women seek to have children later, even when their natural fertility may have otherwise declined. Women undergo egg freezing for <a href="https://theconversation.com/why-women-choose-to-freeze-their-eggs-new-research-95087">many different reasons</a> including illness or medical treatment (such as chemotherapy) that may leave them infertile, or because they lack a partner.</p>
<p>To <a href="https://theconversation.com/six-things-you-should-know-if-you-are-considering-freezing-your-eggs-94039">freeze their eggs</a>, a woman must undergo hormonal stimulation which helps her to produce more eggs than she would in her normal monthly cycle. Then, these eggs are surgically retrieved and frozen at -196°C for potential future use. </p>
<p>When egg freezing was first legalised and regulated in the UK in 2000, there were many unknowns about who would use the technology, why, and about how long the frozen eggs would remain viable. It’s now widely accepted that once frozen, eggs do <a href="https://www.degruyter.com/document/doi/10.18574/9781479868148/html">not age or decay</a> – so may be viable indefinitely. </p>
<figure class="align-center ">
<img alt="A woman is speaking with her gynaecologist. The gynaecologist is using a notebook to explain something." src="https://images.theconversation.com/files/419805/original/file-20210907-24-14mtyds.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/419805/original/file-20210907-24-14mtyds.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/419805/original/file-20210907-24-14mtyds.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/419805/original/file-20210907-24-14mtyds.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/419805/original/file-20210907-24-14mtyds.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/419805/original/file-20210907-24-14mtyds.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/419805/original/file-20210907-24-14mtyds.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women may choose to freeze their eggs for many different reasons.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-visiting-her-gynecologist-clinic-1351229036">Pixel-Shot/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Before the pending change in regulations, only women who were freezing their eggs for medical reasons – such as chemotherapy – could store their eggs for up to 55 years. Women undergoing the procedure for social reasons (such as lacking a partner) were only able to freeze their eggs for up to ten years – at which point their eggs would have to be used or destroyed. But based on what we know about egg freezing, there was no medical reason for this limit – which is why myself and others argued to change it.</p>
<h2>Freedom to choose</h2>
<p>Currently, the <a href="https://pubmed.ncbi.nlm.nih.gov/26099440/">typical woman</a> who freezes her eggs for social reasons is around 37 years of age, single, and earning above average income. </p>
<p>The women I spoke to in my <a href="https://www.tandfonline.com/doi/abs/10.1080/0167482X.2018.1460352">previous research</a> said their decision to freeze their eggs was often shaped by the fear that they were running out of time to find the right partner and start a conventional family. Many also feared rushing into a relationship with the wrong partner just to have a child. Egg freezing gave these women a chance to find the right partner, and <a href="https://journals.sagepub.com/doi/full/10.5153/sro.4187?casa_token=tiey3sM_-kgAAAAA:JEr1WcrbwzvYdEaQlzwmFpu1ZY1u7xwTOiXVucfwJYjSMAG_Agw3nLvXfCrhe3LfMZTBjqF5LxY">build a secure relationship</a>. </p>
<p>Many of the women had also wanted a child for many years and would have preferred actively trying to conceive over freezing their eggs. Others felt they had not deliberately chosen to delay motherhood. Rather, they hadn’t become a mother for reasons outside their control. </p>
<p>Based on my research and <a href="https://www.tandfonline.com/doi/abs/10.1080/13691058.2014.951881">other studies</a> on the subject, egg freezing often isn’t about putting off motherhood for as long as possible. Rather, it’s about maintaining the possibility to have a child with a chosen partner in the future, or when a person feels they’re ready to have a child.</p>
<p><a href="https://journals.sagepub.com/doi/abs/10.1177/1350506817742929">Research</a> also shows that women who freeze their eggs don’t want to pursue motherhood for the first time in their 50s and 60s. Rather, they want the option to use their eggs in their early to <a href="https://journals.sagepub.com/doi/full/10.1177/0003122418796807">mid-40s with a partner of their choosing</a>. </p>
<p>Egg freezing is expensive, invasive, painful and not without risk. While some women may choose to delay motherhood until much later as a result of these storage limit changes, it’s unlikely large numbers of women will delay childbearing as a result. Instead, increased storage time limits are likely to give women the option to use their eggs to conceive when it best suits them.</p><img src="https://counter.theconversation.com/content/167420/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kylie Baldwin received funding from The Foundation for the Sociology of Health and Illness</span></em></p>Frozen eggs will be stored for up to 55 years in the UK.Kylie Baldwin, Senior Lecturer, De Montfort UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1528282021-02-01T16:06:47Z2021-02-01T16:06:47ZEgg freezing is on the up – but new research raises questions about how clinics advertise<figure><img src="https://images.theconversation.com/files/377568/original/file-20210107-23-2t4nfx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/test-tube-sperm-eggs-samples-cryopreservation-612340154">Elena Pavlovich/Shutterstock.com</a></span></figcaption></figure><p>More women in the UK than ever before are considering freezing their eggs, with the sharp rise in inquiries at some of London’s largest clinics attributed to the <a href="https://www.bionews.org.uk/page_152631">COVID-19 pandemic</a>. No wonder perhaps, since social restrictions have impacted single people wishing to couple-up, making it significantly more difficult to go on dates or meet potential partners.</p>
<p>The current prolonged uncertainty about the future has exacerbated the concerns that many single childless women – especially those in their mid-30s – were already reporting, including anxieties about the ticking of their biological clocks and fears over age-related fertility decline. </p>
<p>Sarah, a 36-year-old HR manager who recently came out of a four-year relationship, feels the pandemic could not have come at a more costly time in her personal life. She told me: “I have this constant underlying worry that by the time this all blows over and I can finally meet someone, I might have missed the boat to become a mother.” </p>
<p>It is easy to see why women like Sarah might opt for egg freezing. Yet while this technology can certainly be useful for some women, new research reveals that it may not always be as straightforward as it appears.</p>
<p>Many aspects of egg freezing have been discussed in the media, yet to date, there has been almost no attention paid to the ways in which fertility clinics advertise, market and promote their egg freezing services on their websites, and the quality of information that is available to potential patients considering their options. </p>
<p>In order to address this gap, my colleague Emily Tiemann and I analysed the websites of the UK’s 15 largest fertility clinics offering egg freezing. Our <a href="https://www.sciencedirect.com/science/article/pii/S2405661820300289#!">recently published</a> findings make uncomfortable reading.</p>
<h2>Misleading websites?</h2>
<p>Our research suggests that fertility clinic websites in the UK, taken in general, provide a poor standard of information and, we argue, need to be urgently improved, for reasons of both medical ethics and consumer rights. Of course, as websites are dynamic entities some of them may have already improved or changed since we took our “snapshot” (in June 2019), but our findings nevertheless raise concerns for potential patients.</p>
<p>We found that most of the clinics we looked at presented what we believe is an unbalanced view of egg freezing on their websites, highlighting its potential benefits and failing to adequately discuss its potential risks. Clinics’ websites were also not sufficiently clear and transparent about the cost of an egg freezing cycle, with the average “true” cost exceeding the advertised costs by approximately a third (on average an additional £923).</p>
<p>Finally, we came to the view that clinics did not always provide accurate data or success rates. In fact, of the 15 analysed, we only rated one clinic website as “good” in terms of its quality of information.</p>
<p>We reached out to all 15 clinics for comment. Harley Street Fertility Clinic responded: </p>
<blockquote>
<p>We welcome the Gurtin and Tiemann paper because it aims to improve the quality of information provided to patients. However, we do not necessarily agree with all the metrics and indicators used by the authors as part of their review […] As a clinic, we strive to be clear and transparent in our communications. Hence, we will use the suggestions made in the paper to improve our communications with patients.</p>
</blockquote>
<p>IVI Midland responded by pointing out that since 2019, the clinic had been acquired by CARE Fertility and therefore the website we analysed is no longer active. CARE Fertility, meanwhile, replied:</p>
<blockquote>
<p>The number of egg freezing cycles we carry out is very small, and as success rate data is only available once a woman returns for fertility treatment (often many years later), we have even less success rate data […] At the time of the study in June 2019, the egg freezing page of our website could have more clearly explained the costs involved with egg freezing, but we have since updated the page to further help patients access the information they need.</p>
</blockquote>
<p>The other clinics we approached for comment did not respond. But it is welcome news that some have been working to improve their website content.</p>
<h2>Potential risks</h2>
<p>We have issued an <a href="https://www.sciencedirect.com/science/article/pii/S2405661820300289#!">urgent recommendation</a> for clinic websites to be improved, but it is difficult for the Human Fertilisation and Embryology Authority (HFEA) to enforce such changes when much of the economic or commercial aspects of fertility treatments fall outside its remit. </p>
<p>But the issue is pressing, since we contend that the lack of good quality information compromises the ability of women like Sarah to make truly informed decisions, and leaves them inadequately informed or misinformed about crucial aspects, such as costs to plan for or potential risks to weigh up.</p>
<p>Justine*, a journalist who lives in London, froze her eggs two years ago, aged 38. She told me that although she went to some lengths to research the technology, she still felt unprepared for the reality of how it would feel to freeze her eggs.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1344573536019640320"}"></div></p>
<p>Justine found herself in considerably more physical discomfort than she had expected, feeling bloated, uncomfortable and in pain despite having been told she would be able to go about her normal life before the procedure. Her physical discomforts continued and even worsened after egg collection: </p>
<blockquote>
<p>As the hours passed, I still felt incredibly weak, bloated and short of breath. I called the clinic who just said if you continue to feel bad, then go to A&E. It was at that point I felt very alone. </p>
</blockquote>
<p>She felt that the clinic had relinquished all responsibility. “I went to A&E and was admitted overnight, with a series of tests and observations confirming that I had OHSS,” she said.</p>
<p>While Justine was unlucky to suffer from <a href="https://www.nhs.uk/conditions/ivf/risks/">ovarian hyperstimulation syndrome</a> (OHSS), a rare complication of the IVF and egg freezing processes caused by the production of too many eggs, she felt she lacked information about this potential risk and that the clinic didn’t offer adequate follow-up care.</p>
<h2>Patients or profit?</h2>
<p>The fertility industry is becoming increasingly commercialised, a consideration that is particularly pertinent in the case of egg freezing, which takes place primarily in the private sector. This is an aspect that Lucy van de Wiel, a researcher at Cambridge University’s Reproductive Sociology Research Group, focuses on.</p>
<p>Her new book, <a href="https://nyupress.org/9781479817900/freezing-fertility/">Freezing Fertility</a>, draws attention to the potential conflicts between clinical decision-making or patients’ best interests on the one hand and business and profit motives on the other. Market forces in the fertility industry, political interests underlying regulations, and age-old cultural narratives of gender and motherhood play a role in our reproductive decision-making.</p>
<p>Given this, I would urge women considering egg freezing to look beyond the information on clinic websites. In particular, women may wish to ask clinics for specific and verified data regarding the number of cycles they have performed each year or their success rates.</p>
<p>They may want to ask questions about exactly what is and is not included in advertised pricing, and to consult the HFEA website for an unbiased discussion of the benefits and risks of the technology. It can also be extremely helpful to discuss egg freezing with others who have been through the process, to gain a realistic impression of what it involves.</p>
<p>Despite her difficulties, overall Justine feels “a sense of comfort” knowing that she has frozen eggs in storage, but she does offer a note of caution: </p>
<blockquote>
<p>While the process is presented as being fairly straightforward, it does have powerful physical, emotional and psychological impacts so it is important not to gloss over it as a ‘procedure’ and make sure you have support available.</p>
</blockquote>
<p>*Name and identifying details have been changed.</p><img src="https://counter.theconversation.com/content/152828/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Zeynep Gurtin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>COVID-19 has led to a sharp rise in inquiries at some of London’s largest fertility clinics.Zeynep Gurtin, Lecturer in Women's Health, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1170282019-05-23T04:38:47Z2019-05-23T04:38:47ZMore and more women are freezing their eggs – but only 21% of those who use them have become mothers<figure><img src="https://images.theconversation.com/files/276100/original/file-20190523-187176-v0habl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In vitro fertilisation.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/362617526?src=hVbYuylijRN7zGzsslA1WA-1-7&size=medium_jpg">vchal/Shutterstock</a></span></figcaption></figure><p>As the trend for <a href="https://www.theguardian.com/commentisfree/2019/apr/17/more-women-over-40-pregnant-choices-motherhood">older motherhood</a> continues, amid <a href="https://www.britishfertilitysociety.org.uk/fei/at-what-age-does-fertility-begin-to-decrease/">warnings from experts</a> about the sharp decline in a woman’s fertility in her mid-30s, more and more women are considering egg freezing as a form of “insurance” against age-related infertility.</p>
<p><a href="https://www.hfea.gov.uk/about-us/news-and-press-releases/2019-news-and-press-releases/ivf-more-popular-successful-and-safer-than-ever-but-reasons-for-treatment-are-changing/">Recent figures</a> released by the Human Fertilisation and Embryology Authority (HFEA) confirmed egg freezing to be the fastest growing form of fertility treatment in the UK, with uptake increasing by 10% in the last year.</p>
<p>But what happens when women wish to go back to the clinic to use their frozen eggs to create families? Our <a href="https://doi.org/10.1007/s10815-019-01429-6">latest research</a> reveals for the first time what percentage of them come back to this “safety net” and what percentage succeed in becoming mothers.</p>
<p>We analysed the data of two of London’s largest fertility clinics. We included information on all of the women who had frozen their eggs and all those who had come back to use their eggs to attempt conception between 2008 and 2017.</p>
<h2>The findings</h2>
<p>Over this ten-year period, 129 women – about a fifth of all the women who had frozen their eggs at the clinic – returned to use them. Of these women, just over a third (36%) had originally frozen their eggs for so-called “social” reasons (due to, for example, a concern with reproductive ageing). The remaining two-thirds (64%) had frozen their eggs for a range of clinical reasons (as part of their IVF treatment to “batch” eggs or because there was no sperm sample available on the day of their egg collection).</p>
<p>The overall success rate was 21%, meaning that only one in five women who used their frozen eggs ended up becoming a mother with those eggs. For social egg freezers, this figure was even lower, at 17%. But it is important to note that a further 26% of those who had tried, but so far had been unsuccessful, still had remaining eggs or embryos in storage, which could, hopefully, result in births in the future.</p>
<p>The ages of women freezing eggs ranged from 25 to 45, with an average of 37 years. Almost all (98%) of the women who had frozen their eggs for social reasons were single at the time of egg freezing. They returned to the clinic to thaw their eggs after about five years, at an average age of 43.</p>
<p>Although most women who freeze their eggs for social reasons state that their <a href="https://www.theguardian.com/commentisfree/2017/jul/07/egg-freezing-women-30s-40s-lack-of-eligible-men-knights-shining-armour">main motivation</a> is the desire to “buy time” to find a partner to have a family with, almost half of the women were still single when they returned to use their eggs. As a result, 48% used donor sperm to fertilise their eggs, opting to pursue solo motherhood instead of waiting longer to find a partner.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/274669/original/file-20190515-60560-qfsafd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/274669/original/file-20190515-60560-qfsafd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/274669/original/file-20190515-60560-qfsafd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/274669/original/file-20190515-60560-qfsafd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/274669/original/file-20190515-60560-qfsafd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/274669/original/file-20190515-60560-qfsafd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/274669/original/file-20190515-60560-qfsafd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">48% of women opt for donor sperm.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/medically-accurate-illustration-human-sperms-319477082?src=S2NWYvUqvkX8bKoureUDgQ-1-19">Sebastian Kaulitzki/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>Solo motherhood</h2>
<p>As Ali, whose twins Molly and Monty were conceived using her frozen-thawed eggs and donor sperm, explained, she initially froze her eggs because she hoped that she might find someone to have a family with. But as the years passed, she said:</p>
<blockquote>
<p>I began to consider solo motherhood. I thought that I would be a good mum and I knew that if I didn’t try to have kids using my frozen eggs, then I would always regret it. I will always be grateful to the donor for giving me my children.</p>
</blockquote>
<p>Ali’s story is heartwarming, especially when one sees her beautiful five-year-old twins. But it is also a story of motherhood against the odds. </p>
<p>With the current success rates, most women who freeze their eggs won’t be as fortunate as Ali because egg freezing does not offer any guarantees. Both the number of eggs that are frozen and the age of the woman when she froze them are factors that influence the likelihood of success, but there is also – as with all fertility treatments – an element of chance.</p>
<p>Most of the women who have frozen their eggs have not yet tried to use them. It is likely that many will conceive the natural way, without ever needing to come back to the clinic. Others may change their minds about having children or may, for whatever reason, decide to discard their eggs without using them. But some will simply be waiting for the right circumstances.</p>
<p>In the UK, eggs frozen for social reasons can be stored for up to <a href="https://www.bbc.co.uk/news/health-46923329">ten years</a> (those for medical reasons can do so for up to 55 years), so we won’t have conclusive data on what decisions women make following egg freezing until their storage period has expired. It is likely that more women, especially those who froze their eggs in recent years, will try to use them in the future. As more women come back to clinics, larger studies can and should be conducted, but until then our data provides the most comprehensive insight available and should be used to help women make better-informed decisions.</p>
<p>Ali notes that although she thinks egg freezing gave her “an amazing opportunity”, she didn’t realise how hard it would be to conceive until she came back to use her eggs. “It took all 27 eggs I had frozen to have my twins, so it was a close call,” she says. “I was almost starting to panic!”</p>
<p>While I know that egg freezing can be a positive option for some women and strongly believe that all women should be supported in making the reproductive choices that best suit them, I think we need to be clearer about the real likelihood of this technology leading to future motherhood.</p><img src="https://counter.theconversation.com/content/117028/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The research for this publication was funded by, and undertaken at, The London Women’s Clinic. This article represents Zeynep Gurtin's independent views and does not necessarily represent the views of other authors on the paper.</span></em></p>New research can for the first time tell us what happens when women wish to go back to the clinic to use their frozen eggs.Zeynep Gurtin, Lecturer in Women's Health, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1012232018-08-08T09:57:43Z2018-08-08T09:57:43ZEgg freezing: the reality of putting your fertility on ice<figure><img src="https://images.theconversation.com/files/230953/original/file-20180807-7141-1119mza.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Egg freezing: hope or hype?</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>When people think of women freezing their eggs, it’s often seen as something to do if you want to get ahead in your career – a way of delaying motherhood. <a href="https://theconversation.com/was-egg-freezing-a-perk-too-far-from-facebook-and-apple-33212">Some companies</a> have even <a href="https://www.theguardian.com/technology/2014/oct/15/apple-facebook-offer-freeze-eggs-female-employees">offered funding for the procedure for their female staff</a>.</p>
<p>Egg freezing allows women not yet ready for motherhood, to undergo a procedure to remove and freeze a number of healthy eggs <a href="https://theconversation.com/six-things-you-should-know-if-you-are-considering-freezing-your-eggs-94039">for potential future use</a>. Supporters of this technology <a href="https://www.hfea.gov.uk/treatments/fertility-preservation/egg-freezing/">point to data</a> which show how higher egg freezing survival rates, as well as pregnancy rates can be achieved using a new egg freezing technique. This is called <a href="https://www.sciencedirect.com/science/article/pii/S1110569012000696">vitrification</a>, and it has the potential to rival the success rates observed when using fresh eggs. </p>
<p>But caution has been called for over so-called “social egg freezing”,
by the <a href="https://www.theguardian.com/science/2018/aug/08/women-need-more-realistic-data-on-egg-freezing-success-say-experts">Royal College of Obstetricians and Gynaecologists</a>. In its <a href="https://www.rcog.org.uk/en/news/rcog-suggests-caution-over-social-egg-freezing/">latest report</a>, it noted that while this technology has the potential to offer some women the possibility of delaying motherhood until later in life, the procedure does not guarantee a future live birth, carries risk, and can be very expensive. </p>
<h2>The women who freeze</h2>
<p>Despite the stereotype of the cut throat career woman putting off motherhood for the sake of her job, <a href="https://theconversation.com/why-women-choose-to-freeze-their-eggs-new-research-95087">my research</a> has actually found that many women who choose to use this technology have had difficulties in finding the right partner. </p>
<p>In some cases, women have come out of long-term relationships, which they thought would lead to motherhood, in their thirties. And they are now faced with the possibility of not finding the right partner before the <a href="https://theconversation.com/hard-evidence-does-fertility-really-drop-off-a-cliff-at-35-29113">end of their fertile years</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/qiYArLFmg08?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>As well as a sense of running out of time to find a partner, women are also often motivated to freeze their eggs by a desire to avoid feelings of regret and blame should they one day experience involuntary childlessness. My research shows, for some women, there is also a desire to prevent themselves from entering in to unwise relationships to have a child – what I have termed “panic partnering”.</p>
<h2>Lack of information</h2>
<p>Due to the relative novelty of the technology, <a href="https://theconversation.com/fact-check-is-freezing-human-eggs-really-extremely-unsuccessful-86729">data on the success rates</a> of egg freezing is not yet available – unlike fresh IVF cycles. So potential users must rely on their clinic to provide them with information about how effective the technology is likely to be. </p>
<p>And unfortunately, my research interviewing women who have undergone this procedure, as well as speaking to clinics providing this technology, found that it was not uncommon for women to be provided with poor quality information – specifically, about their likelihood of achieving a live birth with their frozen eggs. </p>
<p>My research indicated that women were sometimes provided an estimate of egg freezing success based on data that was unlikely to be comparable, such as the success rates published by centres outside of the UK, where eggs are taken from much younger women than the average user of egg freezing. </p>
<p>To ensure that egg freezing is not oversold as a way to “stop the biological clock”, women must be given as much individualised information as possible or at the very least be informed of the limitations of current evidence.</p>
<h2>Shame and stigma</h2>
<p>So, the recommendations in the Royal College of Obstetricians and Gynaecologists report, that women should be provided age-specific success rates by a clinic that has plenty of experience with frozen eggs, are to be welcomed. </p>
<p>But what this report – as well as much of the other research on egg freezing – has not yet recognised is how the needs of these fertility patients differ to women who are undergoing IVF to try and conceive. Women freezing their eggs are more likely to be doing so without both the practical, or emotional, support of a partner. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/230955/original/file-20180807-160647-2p086j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/230955/original/file-20180807-160647-2p086j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/230955/original/file-20180807-160647-2p086j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/230955/original/file-20180807-160647-2p086j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/230955/original/file-20180807-160647-2p086j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/230955/original/file-20180807-160647-2p086j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/230955/original/file-20180807-160647-2p086j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Egg freezing can be a difficult experience to go through alone.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Egg freezing can be a highly distressing and emotional experience. Many women report a sense of loneliness, isolation, and stigma associated with their lack of a partner and their “need” to freeze eggs for the future. And in my research, many women said they would appreciate greater sensitivity and understanding from clinic staff about the reasons why they sought to freeze their eggs.</p>
<h2>Control the future</h2>
<p>So while it’s clear that egg freezing has the potential to offer a <a href="https://theconversation.com/from-frozen-ovaries-to-lab-grown-babies-the-future-of-childbirth-59912">future family to some women</a>, this should not detract from the social, economic and political issues that contribute to women’s use of this technology in the first place. This includes discriminatory employment practices, inadequate provision of childcare and men’s attitudes towards fatherhood. </p>
<p>The provision of high quality <a href="https://theconversation.com/sex-education-gets-a-revamp-but-parents-still-allowed-to-opt-kids-out-99551">sex and relationship education</a> as well as clear information about the realities of egg freezing are therefore crucial to try and ensure women and couples are able to attempt parenthood at a time best suited to themselves.</p><img src="https://counter.theconversation.com/content/101223/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kylie Baldwin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Why some women choose to freeze their eggs.Kylie Baldwin, Senior Lecturer, De Montfort UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/950872018-04-25T11:25:40Z2018-04-25T11:25:40ZWhy women choose to freeze their eggs – new research<figure><img src="https://images.theconversation.com/files/216138/original/file-20180424-57617-6qlwn9.jpg?ixlib=rb-1.1.0&rect=0%2C613%2C4977%2C3068&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/173295410?src=sgWyBc4nJE07ebwl-tv3Dg-1-89&size=huge_jpg">Sebastian Kaulitzki/Shutterstock.com</a></span></figcaption></figure><p>The numbers of women undergoing elective egg freezing across the Western world has <a href="https://academic.oup.com/hropen/article/2017/1/hox003/3092404">increased rapidly</a> over the past few years. But little was known about what motivated women to make use of this novel procedure. Our <a href="https://www.tandfonline.com/doi/abs/10.1080/0167482X.2018.1460352">latest research</a>, shows that, contrary to what many people believe, women don’t freeze their eggs for career reasons. They freeze them because they need more time to find a suitable partner, to avoid future regret and to prevent engaging in what we have called “panic partnering”. </p>
<p>All of the 31 women interviewed for our research decided to freeze their eggs because they believed they were running out of time to become a mother. Specifically, we found that the women feared that as they grew older they would be less likely to be able to become a mother in a secure, intimate relationship – conceiving a child who shared genes from parents who were equally committed to parenthood as one another. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/216163/original/file-20180424-57607-2kk3wb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/216163/original/file-20180424-57607-2kk3wb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/216163/original/file-20180424-57607-2kk3wb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/216163/original/file-20180424-57607-2kk3wb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/216163/original/file-20180424-57607-2kk3wb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/216163/original/file-20180424-57607-2kk3wb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/216163/original/file-20180424-57607-2kk3wb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The women in the study wanted to wait for the right partner.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/521228086?src=e2MOhgmTntcSufrGCvU4lA-1-13&size=medium_jpg">Monkey Business Images/Shutterstock.com</a></span>
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<p>At the time of freezing their eggs, 26 women were single and five were in relationships. The five women who froze their eggs while in a relationship did so because they were either unsure of the potential longevity of their partnership, or because they were in new or fledgling relationships where the discussion of parenthood felt premature. </p>
<p>The other women who were single when they froze their eggs had previously been in serious relationships that they thought would lead to motherhood but which had broken down, or they had been in relationships with men who didn’t want to become a father, so they turned to egg freezing in a bid to preserve their fertility.</p>
<p>All of the women reported feeling under significant pressure to find a partner before they reached the end of their fertile lives, but explained how the men they met were often unwilling to settle down or commit to fatherhood. </p>
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<strong>
Read more:
<a href="https://theconversation.com/six-things-you-should-know-if-you-are-considering-freezing-your-eggs-94039">Six things you should know if you are considering freezing your eggs</a>
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<h2>Panic partnering</h2>
<p>We also found that around two-thirds of the women wanted to freeze their eggs so they could avoid panic partnering; that is, entering into a relationship with a partner they would not have otherwise chosen simply to prevent unwanted childlessness in the future. Many of these participants described seeing other women panicked by their biological clock in to less than ideal relationships and described how this was something they wanted to avoid. One participant put it like this:</p>
<blockquote>
<p>I know that these days, there are a lot of women that just decide: oh my god, I am in my late thirties, I am just going to try and get pregnant with the next person that I meet. Whereas I suppose I am a conservative at heart, and I just didn’t want to do that.</p>
</blockquote>
<p>So egg freezing is not only about keeping the option of pursing motherhood with the right partner open in the future, it is also about avoiding pursuing motherhood with the wrong partner in the present.</p>
<p>Over a third of the women in our study also described fearing that if they did not freeze their eggs, they may come to regret their decision, especially if they were later unable to conceive. As a result, for some women, the fear of future regret and blame functioned as a factor that motivated them to make use of egg freezing. As one of the participants put it:</p>
<blockquote>
<p>If I had not had any eggs frozen, but I had thought about doing it, I would have absolutely kicked myself. I would probably never have forgiven myself, and that was one of the motivating factors for doing it.</p>
</blockquote>
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<strong>
Read more:
<a href="https://theconversation.com/fact-check-is-freezing-human-eggs-really-extremely-unsuccessful-86729">Fact Check: Is freezing human eggs really 'extremely unsuccessful'?</a>
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<h2>Underlying health issues</h2>
<p>While elective egg freezing is routinely seen as the decision to freeze eggs for non-medical reasons, over 20% of the women in this research also had an underlying fertility or health issue affecting their decision to undergo the procedure. </p>
<p>The health issues included <a href="https://www.nhs.uk/conditions/endometriosis/">endometriosis</a>, <a href="https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/">polycystic ovary syndrome</a>, blocked fallopian tubes, as well as the perception of being at risk of premature menopause or serious illness. This suggests that the line between freezing for elective reasons and freezing for medical reasons may be more blurred than we first thought. </p>
<p>And while there has been some suggestion that women are freezing their eggs for career reasons, we did not find this in our study, and several women explicitly rejected this representation of their motives. As one woman stated:</p>
<blockquote>
<p>I think the media really misrepresent women who have children later, I don’t know a single woman who have put off having babies because of her career. Not a single woman I have ever met has that been true for. The women that I know that don’t have kids, it is because they have not got the right partner.</p>
</blockquote>
<p>The women in our research froze their eggs to avoid future regret, to hopefully enable themselves to become a mother at the right time, with the right partner, and be a good mother to their child. This is how one woman <a href="http://journals.sagepub.com/doi/abs/10.5153/sro.4187">put it</a>:</p>
<blockquote>
<p>I suppose I think to myself, that’s the best way to be a mother, to be in a stable relationship and be financially secure and be able to provide for your child.</p>
</blockquote><img src="https://counter.theconversation.com/content/95087/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kylie Baldwin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Contrary to popular perception, women don’t freeze their eggs for career reasons.Kylie Baldwin, Senior Lecturer, De Montfort UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/940392018-04-03T12:37:43Z2018-04-03T12:37:43ZSix things you should know if you are considering freezing your eggs<figure><img src="https://images.theconversation.com/files/212644/original/file-20180329-189795-hpdfwc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/193564313?src=sgWyBc4nJE07ebwl-tv3Dg-1-66&size=medium_jpg">nevodka/Shutterstock.com</a></span></figcaption></figure><p>An increasing number of women are freezing their eggs, according to the latest <a href="https://www.hfea.gov.uk/media/2544/hfea-fertility-treatment-2014-2016-trends-and-figures.pdf">data</a> from the UK’s fertility industry regulator, the Human Fertilisation and Embryology Authority. However, there is little guidance for women who are considering preserving their eggs. </p>
<p>I have tried to redress this lack of advice here, using the latest evidence. And here are six things women should consider before freezing their eggs:</p>
<h2>1. Eggs should be frozen when you are young, but not too young</h2>
<p>The highest live birth rates from previously frozen eggs are shown to come from women who undergo the procedure <a href="https://www.ncbi.nlm.nih.gov/pubmed/29223749">before they are 30</a>. However, the average age at which women freeze their eggs is <a href="http://www.rbmojournal.com/article/S1472-6483(15)00202-3/pdf">around 37</a>, with many women freezing their eggs in their late 30s and early 40s. </p>
<p>For the best chance of success at a live birth in the future, it is best to freeze your eggs before you are 36. By doing so, the eggs stored may still be of a sufficient quality for freezing and you are more likely to use them in the future. </p>
<p>Although freezing your eggs in your early 20s may result in a good number of high quality eggs being frozen, you are unlikely to know at this age if you will ever need to use them, and you may, instead, conceive naturally. By freezing your eggs at a slightly older age (but before fertility starts to <a href="https://theconversation.com/hard-evidence-does-fertility-really-drop-off-a-cliff-at-35-29113">decline more rapidly</a>), such as in your early 30s, you will be more likely to make use of your frozen reserve and therefore not undergo a costly procedure unnecessarily.</p>
<h2>2. Eggs can only be stored for ten years</h2>
<p>Another reason why women may not want to freeze their eggs when they are too young – such as in their 20s – is because UK regulation only permits eggs to remain frozen <a href="https://www.ncbi.nlm.nih.gov/pubmed/27555449">for ten years</a>. You can obtain an extension to the storage period, allowing the eggs to remain frozen for up to 55 years, but only if you can demonstrate that you have become prematurely infertile.</p>
<p>A word of warning: if you experience normal age-related fertility decline you won’t be considered prematurely infertile and would not be able to extend the storage period of your eggs. </p>
<h2>3. Not all clinics are equal</h2>
<p>If you are thinking about freezing your eggs, find a clinic that has plenty of experience with the procedure. You should also ask the clinic if they are able to provide you with success rates with egg freezing from their own data. </p>
<p>Some clinics provide average figures based on published data from other clinics. You should also ask to see success rates by age, as the likelihood of achieving a live birth with eggs taken from a 32-year-old is likely to be very different to achieving a live birth with eggs taken from a 39-year-old.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fact-check-is-freezing-human-eggs-really-extremely-unsuccessful-86729">Fact Check: Is freezing human eggs really 'extremely unsuccessful'?</a>
</strong>
</em>
</p>
<hr>
<h2>4. You are likely to lose eggs along the way</h2>
<p>The more eggs you freeze, the more likely you are to have a live birth in the future – as long as the eggs are a good quality. Recent <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Goldman+RH%2C+Racowsky+C%2C+Farland+LV%2C+et+al.+Predicting+the+likelihood">data</a> suggests that to have a 75% chance of having one live birth, a 34-year-old would need to freeze ten eggs. But a woman undergoing the procedure at 37 would need to freeze 20 eggs, and a woman aged 42 would need to freeze 61 eggs to have the same chance of success. </p>
<p>Eggs are lost throughout the process of egg freezing. For example, a 36-year-old woman could produce 15 eggs following stimulation, but some of these eggs may be immature and therefore unsuitable for freezing. Some of these eggs might also not freeze or thaw correctly, may not fertilise, or may not reach blastocyst stage (the stage suitable for implantation). At the end of the process, there may be just four embryos with which to attempt conception. </p>
<p>The birth rate with previously frozen eggs per embryo transfer is <a href="https://www.hfea.gov.uk/media/2544/hfea-fertility-treatment-2014-2016-trends-and-figures.pdf">around 19%</a>, which means that it is possible, even with four embryos, that the procedure might not result in a live birth.</p>
<h2>5. You might need to have the procedure many times</h2>
<p>Egg collection and freezing <a href="https://www.hfea.gov.uk/treatments/fertility-preservation/egg-freezing/">costs around £5,000 in the UK</a>. Storage costs are extra – around £150 to £400 a year.</p>
<p>Research suggests that women should seek to freeze around 15 eggs to have a reasonable chance of future pregnancy. However, the number of eggs collected during one cycle of stimulation and retrieval depends on the woman’s age at the time of undergoing the procedure, her remaining ovarian reserve, and how she responds to the stimulation. As such, some women may produce 15 eggs for storage after one round of treatment whereas others may need to undergo multiple rounds of stimulation and retrieval – with the associated costs – to collect and freeze the same number of eggs. </p>
<p>As well as being expensive, the process of egg freezing and IVF can often be emotionally and physically challenging. It is important to bear this in mind when considering freezing your eggs.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/212663/original/file-20180329-189795-192dnxa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/212663/original/file-20180329-189795-192dnxa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/212663/original/file-20180329-189795-192dnxa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/212663/original/file-20180329-189795-192dnxa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/212663/original/file-20180329-189795-192dnxa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/212663/original/file-20180329-189795-192dnxa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/212663/original/file-20180329-189795-192dnxa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women should freeze around 15 eggs to have a reasonable chance of future pregnancy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/620722475?src=N1XSwMTp88Wdn0nAdFTwLQ-1-5&size=medium_jpg">Africa Studio/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>6. It might not work</h2>
<p>The cumulative live birth rate of egg freezing – which assumes several attempts at IVF with previously frozen eggs – is still only around <a href="http://www.fertstert.org/article/S0015-0282(15)02111-1/fulltext">20%</a> for women who froze eggs when they were 36 years of age. And even when using young, previously frozen eggs to conceive, as seen in donor cycles, older women are still at a higher risk of complications during pregnancy and birth than women attempting motherhood at a younger age.</p><img src="https://counter.theconversation.com/content/94039/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kylie Baldwin receives funding from The Foundation for the Sociology of Health and Illness</span></em></p>If you are looking to freeze your eggs, here are six things to consider.Kylie Baldwin, Senior Lecturer, De Montfort UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/576602016-05-03T04:56:58Z2016-05-03T04:56:58ZWhy women’s eggs run out and what can be done about it<figure><img src="https://images.theconversation.com/files/118296/original/image-20160412-15891-l8xzxf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Unfortunately women only have the eggs they're born with. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/kwbrown/16087993484/">Kyle Brown/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Most women will have been made aware they have a “biological clock” and that it’s ticking. Most know the older women become the harder it is for them to conceive. But most probably don’t know it’s because women are born with a limited supply of eggs, and eventually they will run out.</p>
<p>Eggs are made when women themselves are in the womb. By 20 weeks’ gestation the tiny developing ovaries in a human fetus contain about five million eggs (the technical names for which are gametes, oogonia or oocytes). This is the maximum number of eggs a female will ever have, because new ones stop being made after this time.</p>
<p>For reasons that are still unclear, more than two-thirds of these newly made eggs degenerate in the following months, leaving a much smaller supply of eggs at birth. Egg numbers at birth range anywhere from half to one million.</p>
<p>The eggs present at birth constitute the only supply of eggs a woman will have in her lifetime. This stockpile of eggs, which is called the ovarian reserve, is housed in structures called primordial follicles.</p>
<p>Although quite a few follicles (30-40) start to develop in waves before each ovulation, usually only one follicle makes it to ovulation to release an egg. The rest degenerate over the six-to-eight-week development phase. So a woman actually ovulates only about 400 eggs during her reproductive life. This is about 1% of the pool of follicles ever produced.</p>
<p>By the age of 30, women will have on average only 12% of the number of eggs they had at birth. This number is still sufficient to support fertility for the next few years, provided the ovary is not subjected to external influences such as cancer drugs or serious ovarian surgery.</p>
<h2>But what about IVF?</h2>
<p>IVF can lead to pregnancy, but only if the eggs are healthy. IVF cannot make an unhealthy egg healthy again, given our current state of knowledge and techniques.</p>
<p>The chances of establishing a pregnancy with the assistance of IVF as women age is well documented. It can be 30-45% in women under 38 and <a href="https://npesu.unsw.edu.au/sites/default/files/npesu/data_collection/Assisted%20reproductive%20technology%20in%20Australia%20and%20New%20Zealand%202013.pdf">has been shown</a> to decline to less than 10% after 42 years of age.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/120482/original/image-20160428-30986-1e12z35.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/120482/original/image-20160428-30986-1e12z35.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/120482/original/image-20160428-30986-1e12z35.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/120482/original/image-20160428-30986-1e12z35.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/120482/original/image-20160428-30986-1e12z35.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/120482/original/image-20160428-30986-1e12z35.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/120482/original/image-20160428-30986-1e12z35.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/120482/original/image-20160428-30986-1e12z35.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">IVF can fertilise a healthy egg - but you need that egg to begin with.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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</figure>
<h2>What about freezing eggs?</h2>
<p>Egg freezing can be performed to preserve a number of mature eggs for later use. This involves a process of ten to 12 days of hormone administration to stimulate development of multiple follicles. </p>
<p>The number of follicles that develop depends on the age of the woman and her intrinsic fertility. The <a href="http://dx.doi.org/10.3109/09513590.2015.1062859">average number of eggs</a> collected and subsequently frozen for a 35-year-old woman is about ten.</p>
<p>Although 90-95% of eggs make it through the thawing process, we would still expect only one to three good embryos to develop from that group of ten eggs. This is the same as fresh eggs – about 50% fertilise and then fewer develop to make good embryos.</p>
<p>Both the processes of embryo creation and the pregnancy potential of embryos are similar from fresh and from frozen eggs. But the “normal” loss that occurs, as the eggs are fertilised, made into embryos and then develop, means that at most the process of egg freezing will offer a small finite number of additional opportunities for a woman to conceive in the future. </p>
<h2>Can new technology make new eggs?</h2>
<p>A <a href="http://www.sciencedirect.com/science/article/pii/S1934590916000187">recent report</a> shows new healthy eggs can be made from stem cells. Stem cells are present in human embryos, as embryonic stem cells, and in <a href="http://dx.doi.org/10.1093/molehr/gaw015">most organs</a> including the ovary. Alternatively, an induced form of stem cells can be obtained by treating mature cells with a cocktail of reagents in the laboratory.</p>
<p>The procedures required to create new eggs out of stem cells are very complex and still experimental. There are ethical issues, such as the need to destroy a human embryo to obtain embryonic stem cells, and further experiments will be necessary to show there are no genetic or fertility problems with subsequent generations.</p>
<p>It will require much more research to establish the safety and efficacy of the procedures before they are allowed into clinical use.</p>
<p>Women do not have an unlimited supply of eggs, but it may be possible in the future to create healthy eggs from stem cells in the laboratory. Until such a time, it’s essential all women and men understand the limitations of the fertility of women and plan their lives to take full advantage of the fertile lifespan should they choose to have children.</p><img src="https://counter.theconversation.com/content/57660/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John (Jock) Kerr Findlay received funding from the National Health & Medical Research Council of Australia. He is affiliated with the Robinson Research Institute, University of Adelaide as Chair of its Advisory Board. </span></em></p><p class="fine-print"><em><span>Karla Hutt receives funding from the National Health & Medical Research Council of Australia and the National Breast Cancer Foundation. </span></em></p><p class="fine-print"><em><span>Kate Stern is a minority shareholder of Virtus Health. She is a clinical director at Melbourne IVF and head of clinical research at Melbourne IVF and the Royal Women's Hospital, Melbourne. She receives no external funding. Institutional research projects within these organisations, and with which she is affiliated, have received grants from MSD and Merck-Serono. </span></em></p>Most women will have been made aware they have a ticking biological clock. But most probably don’t know it’s because women are born with a limited supply of eggs, and eventually they will run out.John (Jock) Kerr Findlay, Distinguished Scientist, Hudson InstituteKarla Hutt, Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash UniversityKate Stern, Associate Professor, , The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.