Rational reproduction

By Natasha Loder

Martin Varsavsky, a serial technology entrepreneur, takes a radical view of reproduction. “Sex is great, but maybe it is not the best way to make a baby,” he says. This startling proposition is behind his plan to build a network of clinics offering millennials an alternative to the unreliable and unpredictable business of creating offspring the usual way.

Varsavsky argues that leaving it to nature is risky, especially when people are breeding later and later (see chart on next page): the chances of conceiving fall, not only for women but for men too. At the same time, the chances of a child being born with Down’s syndrome rise with the age of the mother, and those of a child developing autism or schizophrenia rise with the age of the father. The risks remain tiny, but some people would prefer not to take them.

The technology to improve on nature is developing. Healthy eggs and sperm can be frozen while people are young and stored for use later in life. Freezing sperm is a trivial matter, but freezing eggs requires hormone treatments and minor surgery to extract eggs, which must then be frozen safely and stored for years; later they must be thawed, mixed with sperm to create embryos and implanted. The process can be unpleasant for the women who undergo the treatment, and risky for the eggs, which can get damaged, though freezing techniques are improving and raising the survival rate.

The technique was pioneered mainly to help women likely to be rendered sterile by cancer treatments, but there is growing interest in the method as a solution to the problem of the ticking biological clock. Almost 1,000 women in Britain and Denmark were asked about egg freezing in 2014: 19% said they were considering it and another 27% were interested.

Only about 2,000 children are known to have been born as a result of egg freezing, but the procedure is becoming more widely available. Recently the American Society for Reproductive Medicine (ASRM) decided that it was no longer an experimental technique, which will help cancer patients get insurers to cover it; and anecdote suggests that growing numbers of healthy Americans are having it done. In Silicon Valley a few companies, such as Facebook and Apple, offer egg freezing as an employee perk. Those firms evidently reckon that fear of future infertility discourages women from committing themselves to careers. In Britain, where there are (not very up-to-date) data, the number of women having their eggs frozen rose from 2,476 in 2008 to 7,047 in 2013.

EGG FREEZING IS SOMETIMES DESCRIBED AS AN INSURANCE POLICY BUT SUCCESS IS NOT GUARANTEED

Egg freezing is sometimes described as an insurance policy but success is not guaranteed. One study suggests that the failure rate for fertility preservation for a woman aged 25 is 70%. The fertility clinic of the University of Southern California says it has frozen more than 150 women’s eggs, and 15 of the 21 who have returned for their eggs have delivered babies. This would put the failure rate at about 30%. Varsavsky says data from frozen eggs that have been donated to infertile women show pregnancy rates “as high as 80%” on the first try, which sounds a little like the bandwidth promises made by broadband suppliers. The ASRM says more data on the safety, efficacy and cost-effectiveness of egg freezing are needed before it can recommend the procedure.

It is also pretty expensive. The costs of egg freezing are about the same as those of in-vitro fertilisation – about $10,000 in America. Storing eggs costs about $500 a year; thawing, fertilisation and embryo transfer another $5,000. In Britain prices start at about £5,000 ($7,000). In poorer countries it is cheaper. Varsavsky points out that if a mother decides in advance to have multiple children through egg freezing the costs per child are lower, as only one egg-extraction procedure will be needed. Children born this way are, in fact, cheaper by the dozen.

Because infertility is such a big, global market – expected to grow from $9.3 billion in 2012 to $21.6 billion by 2020 – there is bound to be innovation. Ovascience, a Boston-based fertility company, is developing a way of extracting immature egg cells and growing them into eggs. This would mean no hormone treatments would be needed, which would greatly simplify the procedure. Ovascience has also developed a way of improving the quality of older eggs with energy-producing mitochondria from a woman’s own immature egg cells. The technique is still novel, but could some day help older women who want to give birth but do not have any young, frozen eggs.

However, choosing a fertility clinic is no simple business. There are over 450 in America; recommendations largely come through friends, one’s regular doctor or even Angie’s List, a business-review site. In Britain they can be found via the Human Fertilisation and Embryology Authority, a government agency. There is no big global or even national brand, which is why entrepreneurs scent opportunity.

Prelude, the company Varsavsky is launching, will offer screening to ensure embryos are healthy and free of chromosomal abnormalities and congenital illnesses, as well as egg freezing. It faces competition. Progyny, which connects women to clinics online, is already billing itself as the “Uber of the fertility industry”. Another start-up, FertilityIQ, plans to create an online community to connect patients to reliable data about clinics and treatments. The industry, its founders say, is plagued by paid referrals and tainted reviews – problems it aims to address.

The fertility business is just getting off the ground. Until the market matures, and more reliable data on success rates emerge, women will need to decide whether they are willing to put all their eggs in one basket.

Image: Alamy