Income+
Buying time to start a family
Lim Siew May 
Not all women accomplish a key milestone like conceiving and giving birth within the timeline Mother Nature intended – 123Rf
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For some women, it’s just non-bargainable – they wouldn’t trade the ability to bear their own children for anything in life. Yet, not every woman goes through life the way it’s depicted in romance novels, and the way the life of their mothers, sisters, relatives and peers typically unfold.

You know the standard plot – being swept off your feet by Mr Right in the early-to-mid 20s, having a grand wedding by your mid- to late-20s, and being blessed with a bouncy baby by your late-20s or early 30s. However, not all women accomplish a key milestone like conceiving and giving birth within the timeline Mother Nature intended, especially those focused on building their career or business.

So how can women in such situations ensure they are able to bear children later in life?

Enter egg freezing, otherwise known as oocyte cryopreservation. Egg freezing has been used since the late 1990s for women with cancer to preserve their fertility before undergoing treatments like radiation and chemotherapy, which disrupt their fertility.

In recent years, the social egg-freezing trend has emerged with the target group of the procedure expanded to include healthy women wishing to preserve their reproductive potential. In 2014, Facebook and Apple caused a stir when they announced they would be subsidising their female employees’ egg-freezing procedure as part of their employee benefits.

To explain it simply, this procedure involves stimulating the ovaries with hormones to produce more eggs, harvesting the eggs in a 15- to 20-minute minor surgical procedure, then freezing and storing them securely for future use.

When a woman is ready for motherhood, the eggs can be thawed, fertilised and transferred to the uterus as an embryo.

 

High costs

The initial outlay – and the most expensive component of egg freezing – varies from clinic to clinic. One fertility clinic quotes the price at RM13,000-15,000. At the other end of the spectrum, one clinic says it charges RM18,000 to RM22,000. Each clinic quotes a range as opposed to a fixed sum, because the cost varies depending on the amount of drugs used to stimulate the ovaries to produce eggs.

Interestingly, the University of Malaya Medical Centre’s website states that egg freezing costs only RM954. However, an employee reveals the treatment is only for those who choose to do so due to a medical condition, not so much to prolong their reproductive ability as permitted at private fertility clinics.

Next, the proper storing of eggs would require you to pay an annual storage fee. Again, depending on the clinic, this ranges from RM636 to RM1,000 a year.

 

You need to know your priorities. What’s important is within you because it’s your body, says Dr Hoo

Dr Hoo Mei Lin, consultant obstetrician and gynaecologist, fertility specialist at Tropicana Medical Centre in Petaling Jaya, points out that patients are generally recommended to store their eggs for five to 10 years for practical reasons. Theoretically speaking, however, they can be stored forever because when in deep-freeze, the quality of eggs would not be affected by the length of storage.

 

“I’d counsel a woman and tell her that if by a certain age, she is thinking of getting pregnant, she  has to think about the responsibility of bringing up a child. There was a 70-year-old who got pregnant in India, but how practical is this? I’d talk to them about the practicality of bringing up a child at an older age,” she says.

The third part comes in later when you are ready to thaw and fertilise your eggs, then transfer the embryo into the uterus. According to Dr Hoo, this will probably cost you another RM5,000 to RM6,000.

Money aside, the egg-freezing process is going to be an emotional one for a woman who undergoes the procedure, she reveals.

 

Key considerations

Because so much is at stake, it is important to weigh your options carefully. Dr Hoo believes the first thing is to do heavy soul-searching about your priorities. “Children for me have always been important, but this is not the same for everyone,” she says.

“For me personally, and for some women who strive for perfection, the idea of having a child who is not my own (such as through an egg donor), I find it difficult to accept.”

“You need to know where your priorities lie – money you can find, time (to do this procedure) you can find, pain and fear of the needle (hormone injection is required to stimulate egg production) you can overcome,” she says.

“What’s important is within you – not your family, not your husband. It’s you, because it’s your body.”

For those who are sitting on the fence, Dr Hoo poses this question: “Is it going to cripple you financially to freeze your eggs?

“If not, I’d err on the side of caution and freeze my eggs. You don’t know (what lies ahead), that’s why you buy this ‘insurance’.”

Let’s assume the procedure isn’t going to take a toll on your finances. Dr Hoo argues it is worth foregoing some of the finer things in life for this procedure. “If you really think about it, we buy luxury handbags, iPhones and go on overseas trips. We can forego a couple of these items to save up for egg freezing. It’s an investment. What’s the cost of the ability to have a baby?”

By the same token, if you are at an “in-between” age, say late 20s or early 30s, where your career, love life and reproductive ability are at the crossroads, this may make your investment in this procedure the most worthwhile.

“It could be that the right person has not come along, you know you want to have a kid, but you don’t know if the person you’re with is going to be the right person,” Dr Hoo says.

The problem, she says, is that women are born with a number of eggs. Unfortunately, their reproductive lifespan has an expiry date.

“It’s Mother Nature’s way of ensuring that we are at our prime when we get pregnant. Every graph I look at when it comes to fertility or fecundity, I see this trend. After 36, the drop is huge, like a valley there. There’s one more dip at 37, another dip at 40. The dips are huge,” she says.

The way Dr Hoo sees it, egg freezing is akin to buying more time for yourself and preserving your youth. “Even if you become a multi-gazillionaire in eight years, the money isn’t going to buy you that eight years in the reproductive department,” she points out.

‘As a woman and doctor, I’d say you cannot have a price tag on your own fertility. There’s no price tag, it is priceless,’ says Dr Lim

Dr Helena Lim, consultant obstetrician & gynaecologist, fertility specialist and director of KL Fertility & Gynaecology Centre (Monash IVF, KL) concurs.

“A lot of biological potential when we are young and fertile with good eggs, we cannot measure that with any amount of money. It comes so-called freely when we are born with it. Yet when it is gone (when we are older), we can’t use money to buy it back.

“As a woman and doctor, I’d say you cannot have a price tag on your fertility. There’s no price tag, it is so priceless,” she says.

 

Peace of mind

Dr Lim believes that even if you end up conceiving naturally, you enjoy peace of mind of having a fall-back plan. “Assuming you stored your eggs five years ago, then you met someone at 40 and you managed to get pregnant. You may say: ‘I shouldn’t have wasted money five years ago.’

“But at least you have your eggs stored if things don’t work out. If you don’t have an option, then at 40, you can’t get pregnant, you have nothing to fall back on,” says Dr Lim, who believes that it is ideal to get your eggs frozen by age 35.

Patients, notes Dr Hoo, typically take a few years to think through their egg-freezing decision. As such, women should start exploring their reproductive options much earlier than today’s norm, she advises.

“Many women think reproductive challenges will not happen to them, and that Mr Right will just be around the corner. My advice is to start thinking about whether egg freezing is for you at 30, not 40 like most women do now. It’s too late to think about this at 40.

“When you want to invest in something like that, invest it in your prime. Freezing your eggs before 35 is better, but by 30 is best. Personally, I’d cut off at 33,” she says.

She acknowledges that this procedure will not appeal to everyone. While the cost may be prohibitive, if you believe this to be important enough, factor it into your long-term plans, Dr Hoo urges.

 

Unrealistic option for many

Meanwhile, Chong Sui Wei, a former financial adviser, strongly believes the high cost of egg freezing makes the procedure out of reach for the masses.

Chong believes the high cost of egg freezing makes the procedure out of reach for the masses

“If you have lots of commitments and are thinking about survival now, this procedure will seem like a luxury to you. People in this category are already having a hard time taking care of themselves, why should they consider egg freezing?” she questions.

Realistically speaking, it will take an average wage-earner many years to save up for the required amount. She points to the example of a cosmopolitan working woman who earns RM6,000 a month, and has a take-home pay of about RM4,500. “Let’s assume she can set aside RM600 as savings. If the procedure is RM18,000, and she sets aside all her savings for this procedure, it will still take more than two years to save up,” Chong points out.

Factor in other competing goals, and this procedure will seem even more unattainable. “Don’t forget – in reality, she may also want to put some of her savings aside for retirement and emergencies – which will leave her with a smaller amount to set aside for the procedure,” adds Chong.

In her view, if the government wants to encourage people to have children, it should allow people to withdraw money from the Employees Provident Fund for this procedure.

All in all, Chong agrees that this very much depends on a person’s values and financial ability. “It is very subjective and personal. Some of my friends got married late, and they just accept that they are not able to have children.”

Chong envisions that a more ideal candidate for egg freezing would be a single woman who is about 30 years old, and has a monthly take-home pay of around RM10,000. Suffice to say, she feels strongly about having her own offspring one day.

This ideal candidate, however, will be far and few in between, Chong predicts. “I am not sure how many people would do this as it is quite costly, and if saving up for a downpayment for a property is the priority. Personally, I think this is not something that everyone would think about doing, unless they have excess money and are aware of the procedure.”

Check your hormones first

Whether it’s worth freezing your eggs will also depend on the number of eggs you have left, which the Anti Müllerian Hormone (AMH) test enables you to find out. FocusM gathers that this test costs about RM300 to RM500.

According to Dr Hoo Mei Lin, consultant obstetrician & gynaecologist, fertility specialist at Tropicana Medical Centre in Petaling Jaya, there’s a hormone produced by all follicles in your ovaries. “The more potential eggs you have, the higher is the AMH level. If it gets to a very low level, where you need to pump in lots of hormones to produce eggs, then it is not cost effective to freeze your eggs,” she says.

Dr Hoo encourages aspiring patients to try the AMH test first, especially if she’s on the cusp, like 36. “I always tell my patients, this test tells you how much time you have left,” she explains. In fact, she even gets younger patients who are over 30 to take the test.

“Some patients who are in their early 30s have unexpectedly low AMH. They need to escalate their consideration on freezing their eggs. If you are in your early 30s, and your AMH is already low, you cannot wait for another couple of years to do this,” she says.

That said, the AMH test is not without its shortcomings. Dr Hoo points out that it only tells you the number of eggs, but not their quality. “You may have a good number of eggs, but once you reach the 40s, about 40-60% of your eggs could be abnormal,” she cautions.

 

Conflicting perspectives on egg freezing

One reason that makes egg freezing a dilemma is the conflicting data and positions adopted by various industry players – making it difficult to decide if the prohibitive costs (financially and emotionally) are worth the potential rewards.

The procedure, after all, does not guarantee fertility. Also, if you are a non-married Muslim woman, this is not a viable option based on Shariah laws, a local daily reported.

In late 2012, the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) announced that they would no longer consider oocyte cryopreservation or egg freezing to be experimental, notes The National Center for Biotechnology Information (NCBI).

However, the following year, the ASRM and SART jointly cautioned against the use of egg freezing as a protection against age-related fertility decline, attributing it to limited data about the safety, efficacy, cost-effectiveness and emotional risks of egg freezing for healthy women of reproductive age.

The ASRM–SART joint practice guideline was further endorsed by the American College of Obstetricians and Gynaecologists (ACOG) in 2014, which supports egg freezing for medical reasons only, NCBI reports.

Ironically, NCBI points out that within the same year, the Canadian Fertility and Andrology Society directly contradicted both the ASRM–SART practice guideline and the ACOG, describing the procedure as “an option for women wishing to preserve their fertility in the face of anticipated decline,” even when no new clinical data were presented to endorse this position statement.

Back home, Concept Fertility Centre (Malaysia) also cautions that results from cryopreserved eggs have been – and still are – somewhat variable.

It concludes that in spite of the high cost, frozen eggs have lower survival rate, low fertilisation rate and low live birth rate (birth of at least one live infant).

 

 



This article first appeared in Focus Malaysia Issue 254.