Social Freezing
Eng Transcript
Florestan
Adler: You really want to have kids, don’t you? It’s not so much you saying ‘one day I will have kids’, but more like a maternal
need.
Marilyne Lironi: No, it’s more like ‘one day I will have children.’
[Laughter]
Marilyne Lironi: But that’s in the future! If you’re talking about
your future, then clearly, I will have children.
Mélissa Vuillet: Is it really the right time to be thinking about
this? It should be, seeing as our biological clock is ticking. But really, in
this current situation, are we really asking ourselves this question?
00.28 VO: This
is very much the question on everyone’s mind. Melissa, Charlotte, Solene, Maryline, Florestan, Simon et Julien are between 21 and 27 years old.
Soon they will no longer be students, and are thinking about their future in
work, raising a family, and how they might reconcile obligation with ambition
and desire.
Cheers!
Florestan
Adler: Maybe you’ve got other priorities, things to do other than have kids at
any cost once you’re 25. You’ve got to make the most of life; once you have
kids, your life revolves around them.
Charlotte Theytaz: People that have done shorter degrees and are my
age or maybe even younger already have children.
Solène Perruchoud: If I hadn’t gone into higher education, and I
had a stable love life, it would be a whole other story. Because now I think
I’m in great shape to start a family.
Marilyne Lironi: When we look around us, as students, most of us say
that we want kids, but in a few years…
01.30 VO: The
nature of the human body dictates that the ideal age to have children is
between 20 and 25 years old.
This window
of peak fertility is the same for both men and women, despite the fact that
female fertility deteriorates more rapidly from the age of 30.
01.48 VO: Mélissa Catoquessa is 26 years
old. Her situation perfectly encapsulates the dilemma of the modern female student.
She works two jobs to finance her studies in English and History, as well as
giving private tuition. On top of all that, she also does dancing and acts – she
barely has time to catch a breath.
Interviewer:
Do you see yourself raising a kid in all that?
Mélissa Catoquessa: No, not really. It’s not possible, I just
wouldn’t have the time. I still have four years of studying to finish the
course if I want to qualify to teach. And if I decide to do a PhD, that’ll be
another four, so that would be eight years. So that’s a fair amount of time,
I’m nowhere near finishing yet! By then I’ll be 34-35 years old.
02.32 VO: Since
finding out about the procedure, Mélissa is seriously
considering freezing her eggs. The only obstacle lying in wait for the student
is the 5000 Euro pricetag – the other potential
issues don’t bother her.
Mélissa Catoquessa: We live in a time where, if you have the means,
you can satisfy any desire, achieve any number of goals, and when that goal is
being a mother, if I have the option to freeze my oocytes, I’m not going to be
deterred by it being ‘unnatural’.
Interviewer:
In some countries, parents offer it to their daughters.
Mélissa Catoquessa: What an excellent idea! Not bad at all.
Interviewer:
If someone offered it to you for free, would you do it?
Mélissa Catoquessa: Yes, straight away for sure. I would do it
straight away. It’s insurance, because you never know. If the mood takes me
when I’m 35-38 years old, if I’ve frozen some of my oocytes, I’d have a backup
in case things didn’t work out naturally.
03.39 VO: The
marketing strategy promising ‘fertility insurance’ has featured in online
campaigns for arouynd three years now. Commercials
feature prominently on television in the United States, as pundits recount
their success stories between two unabashed adverts for egg freezing. The hype
is driven by an idea of consumer-feminism, driven by career, power, and the
right to one’s own body.
04.03 VO: Some
fertility clinics even organise induction workshops – so-called ‘egg freezing parties’.
The medical procedure is explained to young women who show an interest,
alongside appetisers and champagne. Emphasis is placed on mitigating the cost,
with long term repayment plans available to those concerned.
Marilyne Lironi:
For starters
I didn’t think it was an option for people who were in good health, i.e. if you
had cancer, you’d freeze your eggs etc. That we’re familiar with, and we get
the medical incentive. But I’ve never considered it. I never said to myself
‘well, my studies or my career are taking off, I want to stick with my career
for a bit longer, could I freeze my eggs?’ I’ve never really thought about
it.
Simon Vouga:
Society is
evolving, technology is evolving, science is evolving, so now you don’t
necessarily have to choose when it’s forced upon you.
Florestan
Adler:
In any case,
the older you get, the harder it is to have children whether you’re a man or a
woman. You’re better off planning well in advance, and freezing them early.
Because you’d feel pretty daft if you turned around at
42 and couldn’t have children because you’re not in the optimal condition for
it or for any other reason.
Solène Perruchoud:
If I get to
35 and they say to me: ‘It’s too late’, I don’t think I could take it. You’d
have to live with knowing that you had the chance to do something about it when
you were younger. That’s what I’m most afraid of – regret. To turn to
yourself and admit: ‘Dam! I should’ve done something about it sooner.’
So I guess
that means that your taking this seriously?
I’m taking
this very seriously.
05.38 Initially
developed to combat sterility, egg freezing has provided as many
head-scratching ethical dilemmas as it had solutions to real-world problems.
Bologne,
Italy, is home to the oldest university in Europe, built in the 11th
century. It’s department for reproductive medicine, led by Eleonora Porcu (Poor-cew), is
internationally renound thanks in part to its
turbulent history. In 1960, a medical experiment here in Bologne
proved immensely controversial.
Pr. Daniele
Petrucci (pet-ru-she) and his collegues
allowed an embryo to grow for 29 days inside a test tube. The Catholic Church,
as well as parts of the scientific community, were outraged, and it didn’t take
long for the story to grab the attention of the general
public.
Jean
Rostand, biologist, archive footage
You mean to
say that from the moment we created this pregnancy in a testube
that the human embryo would jump up and thank the scientists, the man who would
seek to modify it. I will not deny that all that is at the same time
enthusiastic but also very worrying.
07.00 The
experiment failed to yield any concrete results for sterile couples – at least
not immediately. One would have to wait nearly 20 years to witness history’s first
testtube baby, as Louise Brown earned the title in
Great Britain, 1978.
The real
strength of invitro fertilisation is that it can successfully take an ovum from
the mother without causing any damage to either the cell, or the patient. At
the time, the procedure was carried out with trocars which penetrated the
abdominal wall of the mother.
The egg and
the sperm are brought together in a test tube.
But using
fresh cells causes complications: the number of fertilisations increases, as
does the loss of embryos.
07.55 The
next breakthrough would come with the ability to freeze embryos. In 1984, Zoe
would become the first baby to be born from an embryo frozen in liquid
nitrogen. But whilst freezing embryos and sperm is simple enough, freezing an ovum
remained out of reach.
In Bologne, just as in labs across the world, scientists like
Eleonora Porcu’s team looked for a solution.
Prof.
Eleonora Porcu, Unité infertilité et PMA, Hôpital Universitaire Sant’Orsola-Malpighi,
Bologne
Because of
the fragile nature of the eggs, due to the large volume of water they contain,
they are very vulnerable and are easily damaged.
08.33 The freezing
causes crystals to form which can damage the cell. Whether freezing is
undertaken quickly, known as vitrification, or much more slowly, the ovum is
still damaged. Most fertility clinics have therefore forgone the use of frozen ova.
But not Eleonora Porcu.
People can’t
believe it – they tell me not to take on this challenge, that it’s not worth
the effort, that it won’t work – game over. But I’m very stubborn, and I
continued to think that it was an alternative and I kept working at it,
carrying out experiments with my team of biologists and we tried a number of things – changing the solution, using cryoprotections,
which help to shield the cell from the cold.
9.43 In the
end, the use of cyro-conservation fluid is a success
– the ovum is protected. It survives the freezing and un-freezing process. But
bizarrely, this has yet to result in a successful pregnancy.
Prof.
Eleonora Porcu
The ovules
are surrounded by an external membrane, which is known as the zona pellucid,
which, with the cold, can harden and render penetration by the sperm more
difficult. So I said to myself: why don’t we just put
it straight in via ICSI? That way we may increase the chance of a successful
fertilisation.
10.24 ICSI
stands for ‘Intra Cytoplasmic Sperm Injection’, developed in Belgium to treat
male infertility. It involves injecting the deficient sperm directly into the ovum.
This was Eleonora Porcu’s stroke of genius – give the
sperm a helping hand, even if they are perfectly healthy - And it worked. Following
the breakthrough, the gynocologist carried out her
first ICSI on one of her patients.
Prof.
Eleonora Porcu
After 2
weeks, having received a positive pregnancy test, I touched the sky – I was so
happy because I had finally got a solid result for my patient, for this couple,
but most of all I was aware that we were on the cusp of something
revolutionary.
11.25
[TRANSLATE HEADLINE IN SUBS]
It’s a
miracle. A little girl is brought to the world in 1997. The press lavish praise
on Eleonora’s achievement, opening the door to a world of possibilities. Her
method can be reproduced with relative ease, and vey quickly she finds herself
on a world tour of fertility clinics, all of which adopt her techniques. Young women at risk of cancer or particularly
harsh menopause can once again aspire to motherhood should they wish.
Prof.
Eleonora Porcu
Freezing
eggs means that they belong to the woman alone. It’s her little treasure that
she can keep for herself, and use as she wants, including with another man, another
husband, another life, and that’s very important.
12.23 Prior
to Eleonora’s breakthrough, only fertilised embryos could be preserved. This meant
that a young person, most likely still single who became afflicted by serious
illness, would be unable to secure a chance to have children down the road.
This was what Eleonora initially set out to change – yet she could never have
imagined where her initial success might lead.
Prof. René Frydmann, Spécialiste PMA, Hôpital Foch, Paris
René Frydmann – it so happens that today is 35 years to the day
that Amandine was born. Did you imagine at the time that the technology would
develop so quickly, and that we would find ourselves in a situation where we
could offer women the opportunity to freeze their egg cells in
order to preserve their fertility?
No,
objectively at that point we were so preoccupied with women coming to us with
issues around infidelity, because it was in the wake of the sexual revolution,
’68 and all that, society was changing, there was no protection, there was no
contraception, and at that point we saw a great many sexually transmitted
disease. So we were really working with the herd on things like tubal pathologies,, as they say, or tubal infections. Nowadays
that sector is just a small percentage, about 10%. 90% - that’s something else.
And that’s
often the age at which you get the first pregnancies?
Exactly, so
then we were confronted with another phenomenon which is more physiological,
which is the irrefutable point that fertility decreases over time, especially
for women approaching 40. From 40, 43 years of age, your chances of success are
in single digits.
Do you think
that freezing gametes, ovules or sperm could be a solution in the future?
It is a
solution, but it is not the solution, because we should be weary of over
promising. For starters it doesn’t work every time, which is by no means a
negligible constraint. You have to weigh up the
positives against the negatives. I think what is important is informing people
about the way age impacts fertility. That would buy time for people who,
currently, turn up to the doctors at 40 and say ‘But
doctor, I didn’t know that fertility decreased with age – I’ve just read in
People Magazine that my favourite actress who is 50 is happily pregnant?’
And do you
think that in the not too distant future, suggesting this to prevent a drop in fertility a bit like we suggest vaccines, we’ll
suggest to young people aged between 20 and 25 that they should freeze eggs
just incase?
At 20-25,
you start talking about their future children, you’re going to find yourself up
against the wall. They’re not there in the slightest. They don’t want children,
they want to live, to enjoy life’s pleasures, to have sex, so it’s not the
right time. If you try that, you won’t be heard.
But it is
the ideal age to freeze eggs isn’t it?
True, but
you must also acknowledge that to warn someone, there must be an event to warn
them about, and at 20 your not going to think about
infertility because you still have 15 years ahead of you.
If a woman undergoes
a conservation of her eggs, which she pays for herself, do you think that there
should be restrictions on how these eggs can be used? Should they put a limit
on women or not?
I think that
restrictions put in place regarding medically assisted pregnancies in France
limiting them to those under 50 are a good thing.
Why?
Because
after 50, pregnancies become complicated and there is a higher risk of problems
arising. Everyone has heard the heartwarming success stories,
but the risks remain , especially relating to
cardio-vascular issues. There is an age to be a grandmother and an age to be a
mother.
Thank you René
Frydmann
Thank you.
16.12 In
spite of all of this, there seems to be no stopping the increase in the average
age of the first pregnancy: in 1970 it was 25. Now, it’s over 30.
In
Switzerland it is illegal to use another woman’s eggs, hence the incentive to
preserve one’s own. It is a procedure recommended by fertility consultants in
public hospitals as well as private practices like here, at the CPMA at
Lausanne.
This is
where Dorothea Wunder specialises in infertility. We
don’t know for sure exactly how many women have made use of social freezing as
there is no official register. But based on the data in each centre, we can
estimate that this number is around a few hundred per year across the whole
country. At the CPMA, demand is steady at about 40 women a year – nothing
compared to the boom in the United States.
How would
you describe the typical client who comes to you for social freezing?
Dr Dorothea Wunder, Médecin spécialiste de l’infertifilité,
CPMA, Lausanne
So contrary
to what you might initially imagine, it’s not a woman who comes to us because
she wants to have a career into her 40s, in a stable relationship, who wants to
wait until almost 50 to have her first child. It’s more often a woman who has
just been separated from their partner and who is 35, nearly 40 years old who
desperately wants a family, but who is alone. She wants to maintain the hope
that she could one day start a family.
17.53 Once
she has been made aware of the chances of success – as well as the risks - the
patient will be stimulated to trigger a super-ovulation.
Just as we
would do with an IVF treatment, we would give a large dose subcutaneous
injection in the evening. The goal is to get around 10 or 12 eggs.
So we
prick, like that.
It’s a very
stressful treatment which takes about two weeks. You get an injection every
day, sometimes twice in one day. You have to come in
for tests, have blood samples taken, inspections carried out… it’s relatively
stressful. It takes about as long as it would naturally, about 12 to 14 days to
get to the stage of maturity where we can remove the eggs.
18.46 The
procedure has improved considerably since the 1980s. Gone are the giant trocars
in the stomach. A needle inserted vaginally under a small aesthetic permits the
extraction of the ova.
These large circles which you see are the
follicles, which we are about to puncture. It goes into the follicle, and now
it absorbs all of the liquid with the eggs inside
them. This liquid them flows through the tubes, which will be sent immediately
to the laboratory after the puncture.
There remain
no more follicles, we punctured everything and have finished the intervention.
With women
younger than 35 with 5 eggs you have a roughly 15% chance of a pregnancy, and if
we have 15 eggs, you can raise that to about 85%, so it’s not quite 100% but
it’s still very good. However if the woman is closer
to her 40s, the chances of a pregnancy are drastically reduced. With 5 eggs we
have a maximum of 5% chance of a pregnancy, and with 11 eggs it’s only 15%.
There are fewer eggs, and those that we do have are less likely to be
fertilised, and there is also an increased risk of stillbirths. Pregnancy is no
guarantee of a child.
20.29 a
further complication comes from the relative novelty of the procedure, which
hasn’t been around long enough for lawmakers to legislate for it, forcing these
centres to operate under the same rules as a sperm bank. This means that they
can only keep hold of the eggs for a maximum of ten years. After that, the law
requires that they be destroyed. This is an absurd ruling, as one can see that
it is far more difficult to obtain a woman’s eggs than a man’s sperm.
At the CHUV
hospital, Nicolas Vulliemoz, who runs the unit for
reproductive medicine, must accommodate this ruling.
Dr Nicolas Vulliemoz, Unité de médecine de la reproduction, CHUV
It is clear
under the current law that the eggs must be destroyed after 10 years, and we
submit to it. However patients often say that if their
eggs belong to them, then it must be possible for the to take the abroad, and
the answer is yes, technically, seeing as the eggs are yours, you’re free to
take them abroad.
The patient
is therefore the owner, not the hospital?
Absolutely,
and we take that very seriously.
21.28 The
woman must equally be made aware of the risks involved in hormonal stimulation.
There is a
risk in what is called ovarian hyperstimulation syndrome, but as it stands,
with the protocols we have in place and the medicines we use to start the
ovulation process, the risk of hyperstimulation is almost zero. There is then
the small surgical procedure – the puncturing of the egg, which like all
surgical procedures, carries its own risks. The risk of infection, of internal
bleeding, of lesions on the intra-abdominal organs, but in reality
it’s an extremely minor procedure with very low risks.
22.02 Health
risks are not only physical - to dream of one day having a child, only to feel
deceived if the procedure fails to deliver, can take its toll on the mental
health of the patient. The price of the stimulation, extraction, and ten-year
conservation period stands at around 5000 dollars, whether you opt for state or
private care. The procedure is not covered by medical insurance, even for those
who are undergoing treatment for cancer. None of this makes the decision any
easier for young women in good health, whose only concern is the passing of
time.
22.35 In
2014, Facebook and Apple began a worldwide debate around this issue by offering
to pay for the procedure for young women on their payroll.
Simon Vouga
I think
offering that to your employees is cool if I’m honest, it means that if the
women can undertake it, then they will.
Florestan
Adler
But to what
end? I think they just want to drag people along for as long as possible, that
all they should do with their lives is work - it’s a form of alienation. You’re
not your career. There isn’t one pre-20th century civilisation to
have prioritised work over procreation. I’m not being sexist – I’m not saying
that all of the responsibility should be on the woman,
but still, it’s a genuine issue.
Charlotte Theytaz
I would feel
a great deal of pressure – I’d feel like refusal would put my job in jeopardy.
That would
genuinely be an issue for you?
Marilyne Lironi
It’s one
thing to be offered when you’re already in the job, but there’s another aspect.
After the interview, you’re hired, and it’s a different sort of pressure.
Because once your in the company, they probably can’t
force you to do it. But what if at interview they ask you whether you’d be interested and you say no, but someone else says yes? It
would influence their thinking, and it could become a way to filter applicants.
It puts more pressure on you.
Solène Perruchoud
I’m asking
myself, would I want to have all these injections, go through the whole procedure,
which is quite demanding, if it turned out that I didn’t want to use it in the
end? Do I really want to put my body through all that?
Simon Vouga
If you
freeze your eggs before the age of 35, you have a better chance of getting
pregnant. Because in fact, the act of freezing them doesn’t guarantee a child
at the end of it. It’s a misleading advert. There are benefits to being able to
push things back, but it’s a scam because you’re not guaranteed anything in the
end.
Florestan
Adler
They’re
pushing this idea that you can have children 10, 15, 20, 30 years late just so
that you can work like mad. I find that quite worrying. It’s a real issue. If
you’re a man, you should really be asking yourself the question. If my boss
came to me as a 30 year old man, tapped me on the sholder and said – ‘hey, come freeze your sperm because we
want you to work at full pelt until you’re 45, without being distracted by
kids’, I wouldn’t like that much. Personally, I find it quite concerning.
Prof.
Eleonora Porcu
Pregnancy is
perceived in the workplace as something which diminishes performance,
capability and effectiveness, therefore you must do everything you can to get
rid of pregnant women in your employment. Since that’s not legal, they’ve
invented this new idea that you must freeze your eggs and push the pregnancy
back to when the woman is in her 50s or older. As a woman who has a very
demanding job, as well as the mother of my daughter, I see this effort to force
women to delay pregnancy into their 50s as an attack on women. It is a
superficial freedom – in reality it’s a masked form of
coercion, made to appear as a liberty. If I could do it all again I would have
three children instead of just one, and I would seek to impose my own rhythms –
that’s what we should all be doing as women and not have our lives dictated to
us by others to the point where we’re forced to undergo invasive surgery. If
you’re healthy and not at risk of losing your fertility, this practice goes
against our nature. It’s true that I invented this procedure and helped to
promote its use, but I still believe that us women should remain the masters of
our eggs and not beholden to outsider’s designs for them.