By Gillian E. St. Lawrence
Special to The Washington Post
Tuesday, July 6, 2010; HE01
When we married in 2001, my husband and I thought about having children someday. It was very important to us, though, that we first be financially stable enough to support them and give them plenty of parenting time.
We were aware of our biological clocks -- who isn't? But before we knew it, we'd been happily married for eight years. I was 30, he was 32, and we still were not ready to be parents. Knowing that time was running out, we resigned ourselves to the fact that we probably would not have children.
Then we found another option: a way to postpone parenthood without risking the higher miscarriage and genetic disorder rates that occur in babies conceived from parents older than 35.
We did this by undergoing in vitro fertilization and freezing our embryos.
Most couples resort to in vitro only after years of trying unsuccessfully to get pregnant, a process I think of as Desperation IVF. Instead, we chose to preserve the advantage of our current youth and fertility. I call it Preservation IVF.
Ironically, we came to this solution because we had given up on having a child. Since I wasn't going to be using my own eggs, I started looking into donating them to infertile women, and in the course of my research I learned a lot about the infertility industry: for instance, that it's usual for women undergoing conventional IVF to take extra hormones and undergo enough egg retrievals to produce several blastocysts, the five- or six-day-old embryos that are sufficiently developed to be implanted in the uterus. One or more blastocysts are implanted "fresh," and the rest are frozen for future attempted pregnancies. So many embryos have been produced that way that today, about 25 percent of all babies born from IVF techniques come from frozen embryos. I also learned that the younger the parents are when they produce the eggs and sperm involved in any conception, whether in the womb or in vitro, the better the chance of a healthy baby.
At some point in my research, it occurred to me: My husband and I could create embryos, freeze them and, essentially, donate them to our future selves.The quest
I knew that IVF clinics had the ability to help us with this. They just had to think outside the box a little. So, early in 2009, I began my quest.
First, I looked online for clinics that did embryo freezing. Then I called them up and said, "I am 30 and my husband is 32, and we don't have any fertility problems, but we are wondering if your clinic would do IVF for us so we can create embryos and just freeze them; just skip the part where you transfer the fresh embryo into the uterus. We don't want to use any of them right now, but we want to save them for later."
Some doctors seemed to think I was crazy. ("Why don't you just wait a couple years and get pregnant at 32?" one said.) But others were encouraging, even applauding us for being proactive. ("If more couples thought like you," said one infertility specialist, "I'd be out of a job.")
Once we found some cooperative clinics, we asked questions and did more research.
First, we considered IVF in general: Would it produce a baby as healthy as one conceived naturally?
Over the past 30 years, millions of IVF babies have been born, and that made for a very broad database. (That sets embryo freezing apart from the relatively new and unproven process of egg freezing, which doesn't have enough of a track record for me to trust it with my future family.)
There's not enough space here to explain, or even refer to, all the reading I did. But, for example, in "100 Questions and Answers About Infertility," Michael DiMattina and John D. Gordon of Dominion Fertility in Arlington described the research on IVF children as "extremely reassuring." The doctors note a possible 2 percentage-point elevation of risk of birth defects among IVF babies. But they, like Carmen Sapienza, a geneticist at Temple University School of Medicine, argue that these excess defects may occur because many couples seeking treatment -- those undergoing Desperation IVF -- may have secondary problems associated with infertility. Young, fertile couples could be expected to have a lower risk.
What does the freezing process do to the embryos? Again, I was reassured by the research. For example, a 2008 study by American Society for Reproductive Medicine reported higher birth weights and lower stillborn rates for frozen-embryo babies than fresh-embryo babies.
Furthermore, freezing technology keeps improving. Drew Tortoriello, a physician with the Sher Institute for Reproductive Medicine in New York, introduced us to vitrification, an ultra-rapid process that prevents the formation of damaging ice crystals in the embryo, which had been a danger in older, slower freezing methods. He reported a successful thaw rate of better than 95 percent.
According to the Society for Assisted Reproductive Technology (http://www.sart.org), which collects data from hundreds of IVF clinics nationwide, when women younger than 35 underwent IVF with fresh embryos, 47 percent resulted in live births; with thawed embryos, the rate was 35 percent. Initially, those success rates did not sound that high. But the numbers referred to a single cycle; most couples, as I said earlier, produce several embryos during IVF, and if the first implantation is unsuccessful, they try again, and the cumulative success rate is much higher.
The most relevant statistics appeared to come from couples who used egg donors to create embryos. Like those couples, my uterus might be 40 years old when it receives an embryo created with eggs from a 30-year-old -- that is, from me. Tortoriello told me that his clinic's 2008 success rate for egg-donor IVF was 68 percent per cycle for a fresh transfer, and 38 percent for frozen embryos. He attributed that difference largely to the fact that "the best embryos tend to get transferred initially with the first, fresh transfer." A woman doing Preservation IVF, he said, "would probably be closer to the fresh donor egg IVF success rate."
Next there was the question of storing our blastocyst embryos.
The clinic would handle the vitrification process. Then the embryos might be transferred to a long-term storage facility, whose chief responsibility is to monitor the temperature of the liquid nitrogen tanks.
From the beginning, I'd been worried about the drugs involved in IVF. Typically, women undergoing treatment get repeated hormone shots that stimulate ovaries to produce numerous eggs, so the clinic can harvest a large number in one or two menstrual cycles. Besides being taxing and time-consuming, the drug injections can cause PMS-type symptoms, pain, missed work. They scared me.
But I learned I had two other options: natural and minimal-stimulation (or mini) IVF.
No fertility drugs are used in natural IVF; a doctor retrieves the single egg that a woman naturally produces each month. Minimal-stimulation IVF involves low-dosage pills or a small number of shots to stimulate the production of just a few extra eggs. Since my young age indicated that I could expect to produce a healthy egg every month, I liked both these choices. The number of side effects would be greatly reduced, and I just felt better about creating our future child with fewer drugs in my body.
A three-cycle package of minimal-stimulation IVF or natural IVF costs about $11,000. Pre-screening evaluations and blood tests cost about $2,000. The annual storage fee for the frozen embryos is $300 to $500 per year, and it costs about $1,000 to $2,000 each time embryos are transferred into the uterus.
Some of the costs may be covered by health insurance. In any case, these amounts didn't seem so large when we read a report in the journal Fertility and Sterility, in which Richard H. Reindollar of Dartmouth estimated the average cost of IVF to be $71,000 for infertile couples.Aiming for five
Finally, we were ready to go. Although we live in Georgetown, we ended up working with two New York City providers: New Hope Fertility Clinic, because it specializes in natural and "mini" IVF; and the Sher Institute, because of its personalized service and impressive success rates.
Based on physician recommendations, our goal was to freeze five embryos. In March 2009, we had a consultation appointment: blood test, sperm test, physical examination and so on. We started the first cycle the next month.
Eventually, we went through four cycles, one natural and three with minimal stimulation, all spaced around our work and travel schedules. Each egg retrieval, in which a physician inserted a very thin needle through the vaginal wall, took only a few minutes. (I chose to have anesthesia, but it's so quick that some women just take a Valium.) Each time, my husband provided a sperm sample -- and yes, this is the man's main involvement in the process. Immediately following an egg's retrieval, it was fertilized in the lab. Five or six days after each cycle, we got a call telling us whether the clinic had been able to freeze an embryo.
By December, we were done.
Our five frozen embryos, which we call our baby blastocysts, will remain in storage until we are ready to use them. Since study after study has indicated that the age of the uterus at the time the embryo is implanted is almost irrelevant to the success rate of achieving a healthy baby, we can wait 10 or 15 years: The chief consideration may well be how old I want to be when I'm raising a teenager.
Upon hearing this, my mother-in-law was quick to ask: "You don't have to wait until you are 40 to use the embryos, right?" No, we do not. We can choose to use them any time. And, of course, my husband and I are still free to have babies the old-fashioned way. We still have all the options we had prior to this project -- but now we have some insurance against future infertility.
St. Lawrence runs a real estate investment company and lives in Georgetown. She will be online to discuss her piece at 11 a.m. ET on Tuesday, July 6.