One of the great reliefs of middle age is not having to give any thought to fertility. That particular hustle, which can blow a hole through a woman’s 30s and early 40s – and even, thanks to the lottery-ticket promise of tiny advances in IVF, later – is mostly in the rear-view mirror by the time 50 rolls around, and what was once all-encompassing fades. For many women, I think, the predominant feeling looking back is: thank God that particular nightmare is over.
A report released this week by the Human Fertilisation and Embryology Authority (HFEA) brings it all flooding back, pinging tiny depth charges off otherwise innocuous-sounding words – “cycle”, “storage”, even “window” gets a look-in – and yanking one back to a fraught and what seemed, at the time, never-ending period.
According to the HFEA, the number of people in the UK seeking fertility treatment has risen in the last few years, as has the average age of patients, as those forced to hit pause during the pandemic resume treatment. The average age at which women have IVF has risen to 36, up by almost a year on 2018 numbers, and five years older than the average age of women conceiving naturally. And the success rates are soaring, too.
“Soaring”, of course, is extremely relative in this landscape, where incremental rises of 1% or 2% in the IVF success rate for women over, say, 40, represent major leaps in what’s possible. More interesting, perhaps, is the genuine surge in numbers of younger women freezing their eggs, from 2,576 cycles in 2019 to 4,215 in 2021, an astonishing jump of 64%. The average age of women who undergo this process in the UK is between 30 and 34, a rise that, elsewhere, is reflected in the number of single women having fertility treatment without men. This figure is up 44% since 2019, almost matched by the rise in the number of women in same-sex partnerships seeking treatment, up 33% in the same period.
All of this speaks to an opening up of an industry that in large parts of the world remains hard to access for all but a few. France only relatively recently relaxed its ban on assisted reproduction for anyone but heterosexual married couples; in Italy, a similar ban remains in place – and that’s before you get to the prohibitive cost. Still, the egg-freezing thing gives me pause. Women trying to pre-empt and mitigate the fertility scramble of their late 30s is a sensible precaution, but it brings its own difficulties.
One of these is, obviously, the false sense of security that can come with the idea of egg-freezing as a magic bullet. Fertility clinics offering donor egg services don’t typically solicit donations from 35-year-old women, for the good reason that the eggs of a 35-year-old are much less likely to be viable than those of a woman in her 20s. The number and quality of a woman’s eggs starts to decline past the age of 30, so when you freeze your eggs matters. Even if you freeze your eggs at 35 and decide to pull the trigger and use them when you are 45, success is far from guaranteed. According to the HFEA report, the birth rate per fresh embryo transferred for patients aged 35 to 37 was 25%.
A bigger problem, perhaps, is that freezing your eggs potentially opens the door to a lot of bet-hedging behaviour. Had the service been more widely available when I was in my early 30s, I would probably have used it, in the interests of pushing back the whole fraught set of decisions for another 10 years. I’m a keep-your-options open kind of person, and that position can be expensive, buying you infinite time to dissemble and defer.
At the age of 38, when I started fertility treatment, it was under propulsion from a huge freak-out (unrestrained by contingency plans) that I had already left it dangerously late. I’ve always thought that panic is an underrated motivational force, without which, I suspect, I would have dithered indefinitely.
On the other hand, the more widely fertility options become available, and the cheaper they become, the less loaded these decisions start to feel. I recall hearing and reading thoughts by older women on when and how younger women should have babies and thinking: “Oh, stay out of it.” Given that the struggle to decide to have kids in the first place can be as hard, if not harder, than the actual process of getting pregnant, the duty owed to younger women by those thankful it’s all in the past is to resist forming an outer circle of people wringing their hands, to share their own experience – and then, pretty swiftly, pipe down.
• This article was amended on 22 June 2023 to clarify text related to the pregnancy success rate for eggs that are frozen in a patient’s 30s but transferred in their 40s.
Emma Brockes is a Guardian columnist
