The rush to extend motherhood

At least 50 women have had their eggs frozen at Montreal clinic

CAROLYN ABRAHAM

MONTREAL From Thursday's Globe and Mail

Women are flying to Montreal from as far away as Hong Kong to freeze their eggs for future use, taking advantage of a new and controversial technology that could make age no barrier to motherhood.

Just two years ago, scientists at the McGill Reproductive Centre announced they had found a relatively reliable way to freeze the human egg, a puzzle that had been one of the most vexing in reproductive medicine.

Since then, 20 babies have been born through that technology and at least 50 women have had their eggs frozen. Most are cancer patients who were about to undergo treatments that could leave them sterile. But about a dozen women have frozen their eggs due to personal circumstances that have so far not made motherhood possible. Others have done it for reasons not even the scientists imagined.

Among them is Melanie Boivin, a 36-year-old freezing her eggs for her seven-year-old daughter who, due to a genetic condition, will never be able to have healthy children. A U.S. executive and a top-flight financier from Hong Kong have also banked eggs in hopes of being able to extend their childbearing years.

Putting off nature has prompted some to condemn the prospect of mothers pushing strollers into their pension years, or allowing one generation to provide eggs to the next. But the forthright director of the McGill Centre, ranked as one of the world's top fertility clinics, makes no apologies for the work.

From behind his desk at the Women's Pavillion at the Royal Victoria Hospital, Seang Lin Tan said he hopes egg-freezing will ultimately allow any woman to hit the snooze button on the so-called biological clock.

"People tell me I'm crazy, but we are facing a decline of population in the Western world," Dr. Tan said. Women now outnumber men in many graduating professions, and go on to pursue successful careers, he said. "The price they have paid is their fertility."

So just as the birth control pill allowed women to separate sex from reproduction, Dr. Tan feels egg-freezing could herald the next phase of liberation, allowing women to separate their biological age from baby-making.

Kutluk Oktay, a renowned expert in preserving fertility at the Centre for Reproductive Medicine and Infertility at Cornell University in New York, said egg-freezing technology has "changed drastically in the last couple of years and is now being seen as the next breakthrough in reproductive medicine."

"The procedure will be seen as an established part of fertility care . . . within the next five years," he predicted.

Although questions remain around which method of freezing eggs is best, Dr. Oktay said McGill's fast-freezing technique -- known as vitrification -- "looks extremely promising."

"McGill has obviously been a leader in the field," he said.

Dr. Tan said McGill has in part earned its international reputation for pioneering egg-freezing because clinics elsewhere, particularly in the United States, have been reluctant to pursue a technology in its infancy.

"It is very competitive there," he said, explaining that an experimental procedure could lower a fertility clinic's success rates. But at his clinic, part of the McGill University Health Centre, basic research is embedded in the culture. The McGill team experimented on the eggs of cows and mice for years before trying it on the eggs of women.

Mei is no stranger to crisscrossing the globe. At 41, the Hong Kong financier divides her time between Asia and North America to serve her clients. But since last summer, Mei's flight plans have included brief stops in Montreal for reasons entirely personal.

Mei, a well-educated, well-read lawyer schooled in both Hong Kong and the U.S., was not aware how quickly her fertility could disappear. But now she understands too well that a woman is born with all the eggs she will ever have in her lifetime and that after the age of 35, the number and quality of these eggs rapidly decline.

"I was too busy with work," said Mei, who has asked that only her Chinese first name be used. "If you would have asked me about this at age 25, I would have said that it's ridiculous."

But Mei has tackled the problem as she does most things in her life -- with meticulous research and determination. In March of 2006, at age 40 and still single, Mei began investigating the possibility of freezing her eggs. She searched studies on the Internet, comparing the success of fast and slow freezing methods and visited six fertility centres from New York to California.

"Some doctors don't even want to take me because they don't want me to drag down their statistics [on success rates]," she said.

Then a Hong Kong doctor who knew Dr. Tan suggested she try McGill. By July of 2006, she was on a plane to undergo her first round of egg freezing.

"I'm very glad I found this clinic." But, she says, it has not been easy.

"I have to try and manage my work and fly to Canada for egg retrieval," she said. "I need to manage my boss, I need to manage my clients . . .they all think I'm very mysterious."

In Hong Kong, Mei takes the fertility drugs that stimulate her ovaries to produce mature eggs. She then undergoes an ultrasound at a Hong Kong clinic where doctors measure and count the number of follicles, or ovarian pockets, in which a woman's eggs reside.

When the numbers look promising, Mei has no time to waste -- the window for retrieving mature eggs is narrow. As Mei put it, "You cannot overcook the pasta." On the same day as a successful ultrasound, she must book her flight, roundtrip from Hong Kong to Toronto to Montreal. There, after her 24-hour global journey, McGill doctors extract her eggs and flash freeze them.

"Some mornings, I don't know whether I should pack my bags," Mei said. "It's very hectic to buy the air ticket in the morning, to fly out and then have the egg-retrieval and then fly back."

She has so far made three trips and 16 of her eggs are currently stored at McGill in liquid nitrogen. But Mei realizes that chances are not high of her 41-year-old eggs yielding a healthy baby, or any baby at all.

"I don't think they will survive," she said. "But I have no choice, I have to try this."

As she speaks about the profound regret of not dealing sooner with her declining fertility, she weeps. Somewhere, in the back of her mind, she had always hoped to have babies, she says, "a big family" even.

"There is a need to tell younger women, to educate them and make them aware," she said. "It's no help to learn this and get serious at 40."

For decades doctors have been freezing both sperm and embryos. But the egg, 90 per cent water, is prone to freezer burn. Its structure can shatter after mere moments in the cold.

Some research groups, including those in Toronto, have found success with a slow-freezing method. But the McGill group, in a method pioneered by researcher Ri-Cheng Chian, developed a flash-freeze protocol that seems comparable to the use of fresh eggs.

In 2005, the McGill Centre received ethics approval to offer egg-freezing to patients who could pay the fee of roughly $4,000. But Dr. Tan is now writing the Quebec government in the hopes of having the fee covered for cancer patients and others who have a medical need to preserve their fertility.

At some clinics, like the one at Cornell, egg-freezing is allowed only for women who have "a medical justification," Dr. Oktay said.

But he added that if the procedure is shown to be "safe and effective," he personally feels there is no reason it should not be used to meet the social demands of women delaying childbearing. Two studies are under way, he said, that are following about 35 babies born of frozen eggs worldwide and so far "there is no obvious increase in anomalies" in those children.

Most recently, however, it is not medical concerns that McGill has had to consider before allowing a woman to freeze her eggs -- but moral ones.

Melanie Boivin's journey to the frontier of reproductive science began when she was already pregnant with her third child. It was then that Ms. Boivin learned that her second child, Flavie, would never be able to have children of her own.

"She is so full of energy, always happy and smiling and I had no clue that she had any physical limitations," Ms. Boivin said in a recent interview at the McGill Centre.

But when Flavie was 4, she noticed how she still struggled to ride a tricycle, or complete a puzzle, tasks that demanded certain motor and cognitive skills. Soon after she learned Flavie had Turner's syndrome.

The genetic condition strikes one in every 2,500 female births and involves a girl having only one full, functioning copy of an X chromosome, instead of two. The X chromosome, among other things, encodes the instructions for female maturation and those with Turner's syndrome are often underdeveloped and suffer from malfunctioning ovaries.

Being pregnant herself at that time, it hit Ms. Boivin particularly hard to think that young Flavie would not be able to have her own children.

"I was living all the joy and excitement of my own pregnancy and I couldn't bear that she would miss that." But once Ms. Boivin digested the shock, she shifted into a mode of information collection that led her to an Ottawa conference in April, 2005. There, she heard a Toronto professor speak of the possibility of donating eggs to women with Turner's syndrome.

Ms. Boivin later approached the professor to ask if she could donate her eggs to Flavie.

But the professor explained that biologically it might not be feasible. By the time Flavie would be old enough to accept such a donation, Ms. Boivin - then 33 - would be too old to donate.

"I asked why I could not freeze my eggs. I did not know that it was not [as easy as freezing] sperm."

But just one month later, in May, McGill doctors announced their egg-freezing success and Ms. Boivin started thinking.

"There were lots of things going through my mind . . . I was concerned with the fact that some people, or maybe even me, would think the baby [that Flavie would carry] would be mine instead of hers.

"But when she's old enough to decide if she wants to use my eggs, I will be at the age of a grandmother, in a different phase of my life."

Ms. Boivin and her partner, Martin Côté, tried to discuss all the ethical issues that might affect their daughter, and felt in the end it would be up to Flavie to decide if she would be willing to carry her biological half-sister as her own child.

It may be too, Ms. Boivin acknowledged, that Flavie's future partner might not be willing to fertilize the egg of his mother-in-law. "If her partner is not comfortable then they should not go forward," she said.

Before McGill could accept her as a patient, Ms. Boivin, who works as a case investigator with the Canadian Food Inspection Agency, had to be interviewed by both a university psychologist and the McGill ethics board.

Such a case had never been heard of before, Dr. Tan said. In a paper the McGill team plans to publish, they note that no law in North America governs egg donation between generations. But they note that the American Society for Reproductive Medicine has found that the use of family members as egg donors is generally ethically acceptable.

Doctors have traditionally been more concerned that mothers would coerce daughters to give them their eggs. Dr. Tan confirmed that the McGill ethics board is reviewing an out-of-country request from a daughter who wants to donate her eggs to her mother, who is remarrying.

But of Flavie's case, Dr. Tan said, "this is motherly love."

As with standard in vitro fertilization treatment, Ms. Boivin has had to take the powerful fertility drugs to stimulate her body's production of mature eggs. The first round last summer left her cramping and as bloated as a woman six months pregnant. But the second round, this past January, was better, she said, and to date, 21 eggs have been collected and frozen.

Ms. Boivin has used her vacation to undergo the procedure, and plans a third round this summer. In total, she estimates the three cycles will cost between $15,000 and $18,000.

"I don't think of it as a gift . . . Parents are there to help [their] children, and if she would have needed anything else, an organ, a kidney, I would give it to her without hesitation."

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