Bos/Hrv/SrpRomânăБългарскиShqipМакедонскиελληνικά 19 Nov 15

Motherhood on Ice: Women Face Egg-Freezing Quandary

Women in the West are being encouraged to freeze their eggs to have a better chance of conceiving later in life. Will the procedure catch on in Serbia and Croatia?

Jasmina Lazic Belgrade and Prague
 Photo: Radmilo Markovic

"I never thought I’d turn 35 without having a family. I’ve always done everything by the book — school, college, job... But motherhood is the only item on my to-do list for life that I’m afraid I’m going to fail," says Ivana, a lawyer from Belgrade.

Her parents have stopped asking her the tiresome question: "What are you waiting for?" She believes they have given up on grandchildren. Ivana asked that her surname not be used in this article, because she feels she has disappointed her parents. At her age, her mother already had two children – Ivana, who was seven years old, and her brother, who was five.

"I’m still single, with no children and I don’t see my status changing significantly in the near future," Ivana says over coffee in a city centre café. She recalls an article she read in the Politika newspaper last December. It reported that almost half of women over 30 in Belgrade do not have children.

"I wasn’t sure whether to feel better now I know there are so many of us or to start seriously worrying," she tells me. "But I’m starting to worry."

Ivana says many of her friends and colleagues are in a similar situation, fearing that — as they get older and their fertility declines — parenthood will pass them by. Two married friends had children with the help of in vitro fertilisation, IVF.

"You're just simply unaware of how quickly the years go by. Suddenly you realise that you're nearing a dead end and you’d give anything to turn back time or to slow it down," Ivana says.

But is there any way to trick nature and slow down the biological clock? Towards the end of last year, two major American companies appeared to give their workers the chance to do exactly that.

Technology giants Apple and Facebook made headlines around the world by offering to cover the cost of freezing employees' egg cells, potentially allowing them to focus on their careers without fearing that they would be deprived of motherhood later on.

The news led to a frenzy of media coverage and comment about "social egg-freezing" — freezing cells not for medical reasons, for example because a woman may become infertile due to chemotherapy, but to give women more control over when they have a child.

The medical director of one of the biggest fertility clinics in Europe said egg-freezing represented a second wave of women's emancipation after the contraceptive pill and could be an ideal 30th birthday present.

But critics have accused clinics of exploiting women’s fears of missing out on motherhood to get them to spend a lot of money on a procedure whose success rate is far from clear.

So let's get back to Balkan reality. How realistic, or wise, is it for women in Serbia and Croatia to freeze their eggs?

Leaving It Late

In theory, anything that helps women conceive when they are older could have considerable appeal. As in many other countries, women in both Serbia and Croatia are waiting longer before having a child, according to official statistics.

In 2013, the average age of mothers in Serbia at the birth of their first child was 26.4 years. Twenty years ago the figure was 24.3 years. In Croatia, the average age of first-time mothers in 2013 was 28 years — three years older than in 1995.

"I thought it would give me a greater chance of having a baby if I met a partner in the next few years"

– 'Clare', British woman who froze her egg cells

The reasons why women are having children later are many and varied. Some women want to establish a career. Others fear losing their jobs if they get pregnant. Some hesitate because they doubt whether they can provide a solid financial future for their children. Others may not have found a partner.

But particularly in the Balkans, women also feel strong social pressure to become mothers — and those who do not have children can be judged harshly. In the Politika article about women over 30 without children, the journalist described the reasons for not having a family as "hedonistic", prompting outrage from some readers.

"Women are not baby machines. I can do whatever I want with my body," said one reader who commented on the story.

"So I have to quit studying and grab the first guy in the street so we can breed like rabbits? Great, thanks for telling me the truth — I obviously have no value unless I keep my mouth shut and have babies," wrote another.

Smiljka Tomanovic, a professor of sociology at the University of Belgrade, says there is a traditional belief in Serbia that a woman is fulfilled only once she becomes a mother.

"You’ll never hear anyone saying that a man is fulfilled by his role as a father, will you?" Tomanovic notes pointedly.

However, the pressure women face is not only social. There is also the ticking of the biological clock. Experts warn that women’s fertility starts falling slowly between the ages of 25 and 35 and then the decline gets steeper, making it difficult for most women to conceive after reaching 40. This goes hand in hand with the fact that, when a woman is older, the risk of an unsuccessful pregnancy or miscarriage is higher.

Cool calculation

In the modern world, insurance is available for almost every eventuality. But can you take out a policy to minimise the risk of not having a baby? This is how egg-freezing is seen by some.

The process is formally known as oocyte cryopreservation. Put simply, it works like this: a woman receives fertility drugs to stimulate the production of egg cells, which are then collected, frozen and stored at a temperature of about minus 190 Celsius. Once they are frozen, they can be stored for years. When a woman decides to start a family, the eggs are thawed and fertilised, then embryos are cultured and placed into the uterus.

In the United States, the price of this procedure is roughly between $10,000 and $15,000 while in Britain it ranges between around £3,500 and £5,000.

The offers by Apple and Facebook to cover the costs may prove highly controversial. Some saw the move as a sign of employers acting responsibly but others viewed it as an act of exploitation — effectively paying women to forget about having children so that they could devote themselves to work.

But the idea that a woman can freeze her eggs for years and then come back to get them, having made a career or found a partner (or both), definitely appeals to some.

One woman who decided to go down this path is Clare, a human resources consultant from Manchester in England, who was 38 when she learned about egg-freezing on the internet.

"I had, just a few weeks prior, split up from a long term partner and felt bereft and lost. In my grief I thought it would be a good project to focus on and it forced me look ahead rather than back," says Clare, a pseudonym used at her request.

She decided to explore the option immediately as her local clinic would not freeze the eggs of women over the age of 38.

"I thought it would give me a greater chance of having a baby if I met a partner in the next few years who really wanted a family. I myself was ambivalent about whether I wanted to be a mum," says Clare, who is now 42.

Clare went to a clinic close to her home at the time. She doubts whether she would have gone ahead if it had not been right on her doorstep.

"The preparation I didn't find too bad and I am phobic about needles but soon got over that because I had to. However the egg retrieval was hideous. I was under Twilight anaesthetic, which is very heavy sedation, so wasn't awake for the process but afterwards it was very sore for a number of hours," Clare recalls.

From first report to flash freezing
  • The first pregnancy from a frozen egg cell was reported in 1986.
  • Egg-freezing was initially used mainly by cancer patients prior to undergoing chemotherapy, which destroys egg cells, and by women facing medical conditions that could lead to infertility.
  • Until a few years ago, many egg cells did not survive the freezing and thawing process.
  • But in recent years experts have developed "flash freezing", also known as vitrification, a quick process which allows more than 90 per cent of frozen eggs to survive.

She had to undergo two rounds of egg-harvesting as the first round was not very successful, yielding only two eggs that could be stored. The second produced seven eggs. This was still not ideal — to be classed as successful, a procedure needed to yield more than 10 eggs.

"But I could not face doing it a third time," she admits. Each round cost £3,000.

Clare saw freezing her eggs as a way of keeping her options open. But, she says: “In reality it has made no difference at all."

"I don’t think it has helped me find a partner as dating since the age of 38 has been very difficult as men my age or even a little bit older are only interested in dating women in their early 30s or younger if they want to have a family, therefore I actually think it was a bit of a waste of time and money," Clare says.

Earlier this year Clare met a partner she is very serious about, who already has two young children. They have discussed her frozen eggs and he is open to the idea of having another child if that is what Clare wants.

But she is still ambivalent about whether being a mother is the right choice for her.

"I think this will be the last year that I store them and I suspect I will have them destroyed at the end of this year. I can store them until I am 45 but I don't see any point in continuing to pay for them to be stored if I'm never going to use them, and I doubt I will use them," she says via email.

Balkan practice

In Serbia and Croatia, the options for women who want to freeze their eggs are extremely limited.

Serbian law does not explicitly forbid social egg-freezing, but it is very rare in local clinics. It is on offer at one private clinic, the Jevremova Special Gynaecology Hospital in Belgrade. The cost of freezing the egg cells is about €500, although this price does not include other costs such as preparatory procedures, medical tests and medication.

"For now, this method is still new and not very familiar to the wider population," says Ana Crnobaric-Obradovic, the clinic's general manager. "That’s why it's very important to support every woman who decides to do it and to inform her about every advantage and disadvantage of postponed motherhood."

First of all, she says, women should understand that the best time to freeze their eggs is between the ages of 25 and 35 because that is when their cells are of the best quality.

"Women usually come to us late, around the age of 40, when their egg reserves are either low or of poor quality"

- Marijana Culibrk, Prague Fertility Centre

In Croatia too, the concept of social egg freezing is not widely discussed. Late last year, Marijana Bivcic, a Croatian student, began an anonymous online survey about women's attitudes to the subject. About 100 women have so far completed the questionnaire and half said they did not know much about the topic.

"During informal discussions and focus groups, I found the same thing," Marijana says.

Croatia's Law on Medically Assisted Fertilisation allows egg-freezing when a woman or man is at risk of infertility for health reasons. It does not specifically mention egg-freezing for social reasons. But Mirna Curkovic from RODA, a Croatian organisation that campaigns for parents' and children's rights, says some clinics have started to offer the procedure.

The Balkan Investigative Reporting Network asked seven clinics in Croatia a series of questions about social egg-freezing, including whether they offered the procedure. Six did not respond while the seventh provided only a brief response, which did not directly answer the questions.

Women from both Serbia and Croatia also have another option — the law does not prevent anyone from going abroad to freeze their egg cells.

Fertility tourism

Prague, the picturesque capital of the Czech Republic, is an attractive destination not just for holidaymakers, but also for people looking for help to have a baby. A friend of Ivana, the Belgrade lawyer, went there two years ago for IVF and now has a daughter.

Dr Daniel Hlinka, senior clinical embryologist at the Prague Fertility Centre, demonstrates the equipment he uses to fertilise egg cells. Photo: Marko Lazic

Prague has become a hub for this branch of medical tourism as it has well-regarded clinics and a fairly liberal legal framework. One particular attraction is IVF using donated egg cells from younger women. This procedure can be performed on women up to the age of 49 under Czech law. The law also stipulates that egg and sperm donors are anonymous, unlike in many European countries, including Croatia.

The Prague Fertility Centre, one of the leading clinics in the field, is about 15 minutes by bus and tram from the heart of the city. The reception area is quiet but filled with people, mainly couples. Some hold hands and there is a sense of hope in the air.

To my surprise, many of the staff speak Serbian. "Half of our patients are from the Balkans," Marijana Culibrk, a coordinator at the centre, tells me. Others come from Germany, Britain and France.

Many people come for IVF using donated cells, which has a higher success rate as the donated eggs come from young women, whose health has been carefully checked.

"An IVF procedure with donor cells is about 60-65 per cent successful. Otherwise it’s about 45 per cent," explains Culibrk in fluent Serbian.

Marijana Culibrk, a coordinator at the Prague Fertility Centre. Photo: Marko Lazic

The centre also offers social egg-freezing at a cost of €2,200. This includes associated medical treatment, tests, collecting and freezing the eggs and storing them for two years. Each additional year of storage costs €150.

But, says Culibrk, not many women choose to freeze their eggs.

"Roughly, it’s fewer than a hundred women," she says. "Women usually come to us late, around the age of 40, when their egg reserves are either low or of poor quality."

On the other side of the city lies the Pronatal clinic, another popular and respected destination for people who want to try IVF. It offers social egg-freezing for around €2,400, which includes storing the eggs for five years.

But here too, says gynaecologist Tonko Mardesic, the clinic's director of medical care, many women come to ask about egg-freezing "10 years too late" — when their fertility is already in decline.

"They're about 38 usually," he says. "Of course, they can freeze their egg cells but they have to be realistic about their expectations."

Tonko Mardesic, gynaecologist and director of medical care at the Pronatal clinic in Prague. Photo: Marko Lazic

No women from the Balkans have come to Pronatal for egg freezing, Mardesic says. Most are from Germany.

"We have frozen egg cells but no babies from them yet," adds Mardesic, another fluent Serbian speaker.

Mardesic notes that when a couple is struggling to conceive, it may not be down to the woman. There is increasing evidence that male fertility is declining too.

But for women, some things seem clear. They need to be aware how quickly their fertility declines, particularly after the age of 35, so they can make an informed decision in good time — about whether they want to try to get pregnant or to freeze their eggs.

"I’d give anything if someone had told me 'freeze your eggs' when I was 32 or 33," says Maja, a 44-year-old marketing expert from Belgrade who has undergone six unsuccessful rounds of IVF.

"I know now that this is pointless after the age of 38," Maja says. "But back then I'd have paid whatever to whoever, wherever."

This article was produced as part of the Balkan Fellowship for Journalistic Excellence, supported by the ERSTE Foundation and Open Society Foundations, in cooperation with the Balkan Investigative Reporting Network.

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