A child is an integral part of most women's life plans. Nature has clear guidelines: A woman is considered fertile from her first menstruation until the onset of menopause, although it is not so easy to get pregnant after the age of 35. In the past, this meant that women should ideally have completed their family planning between the ages of 20 and 30. Those who had not found a suitable partner, were still studying or wanted to wait for a child for career reasons were usually left behind. Women who had cancer and had to undergo chemotherapy had no chance of becoming mothers.

More late mothers

Women today are becoming mothers later and later. They study, continue their education and, quite rightly, want to establish their careers before deciding to have a baby. Many are well over 30 when they start to think seriously about it. However, nature may interfere with their plans. Stress, increasing environmental pollution and food can all be reasons why baby luck doesn't work out. Years of hormonal contraception can also play a role. Then there is the frustration of not being able to have a baby. It is an emotional vicious circle that is hard to break. But the fact is that fertility declines rapidly from the age of 30, even if a woman leads a healthy lifestyle. Of course, there are women over 40 or even 50 who proudly present their babies. But very few of these late mothers had their babies naturally. Artificial insemination and reproductive medicine did. Thanks to various cryopreservation methods, you can order your baby on the day you want it.

Cryopreservation

The word comes from the Greek word for cold: "kryos". It involves freezing body cells in liquid nitrogen. They do not die, but their metabolism is stopped. When they are warmed up again, their vital functions resume. Artificial insemination and reproductive medicine were a sensation 40 years ago; today they are medical routine and it is possible to preserve sperm, testicular tissue and eggs. Under certain circumstances, embryos can also be frozen. There are various cryopreservation techniques.

Slow freezing

Slow freezing has been used successfully for decades. During in vitro fertilisation, a woman is implanted with one to a maximum of three eggs. However, more eggs are usually produced and these can then be frozen using cryopreservation. Up to three cells in the so-called pronuclear stage (before fertilisation is complete) are placed in plastic straws, the ends of which are either sealed or welded with a small steel ball. These straws are gradually cooled down to - 196° Celsius in special computer-controlled preservation equipment. Antifreeze is added beforehand to prevent the formation of ice crystals, which can damage the cells. In this way, they can be stored for several years. The advantage for women is that they only have to undergo the ovary puncture and hormone stimulation once. The survival rate of the stored eggs after thawing is around 70%. In many countries, such as Germany and Switzerland, there is an embryo protection law that does not allow embryos to be cryopreserved. If an existing embryo cannot be transferred in the same cycle, it can be stored for a limited period of time.

This treatment is quite expensive and is not always covered by statutory health insurance in Germany and not at all in Switzerland. In Germany, you would also have to be married and at least 25 years old and no older than 40 (woman) or 50 (man).

Vitrification

This method has been used for about 10 years and is the opposite of slow freezing. The eggs are frozen very quickly and special solutions are added to remove the intracellular water. This prevents the formation of ice crystals, which can damage the cells. However, the relatively high content of antifreeze means that the risk of cytotoxicity is low. Vitrification has the great advantage that both fertilised and unfertilised eggs and even embryos can be cryopreserved with almost no risk. As mentioned above, embryo freezing is only allowed in exceptional cases in Germany and Switzerland under the Embryo Protection Act. Even in countries where embryo selection is allowed, freezing is subject to certain conditions. Depending on the country, the eggs can be stored for different periods of time and, unlike slow freezing, the survival rate after thawing is around 98%. Vitrification therefore allows women to postpone pregnancy as long as they wish. This is useful, for example, when women have to undergo ovarian surgery. It also gives women the chance to become mothers if they have been diagnosed with cancer and are about to undergo chemotherapy. However, it also means that women can save their eggs for 'later' and become pregnant when it fits into their life plans - this is called social freezing.

Social freezing

The eggs are retrieved as a precaution, preserved and only implanted when the woman says "go". As a general rule, the earlier the eggs are frozen, the better. It is recommended that they be frozen before the age of 35. After that, genetic and biological changes reduce the quality of the eggs. Opinions are divided on social freezing. While proponents celebrate it as the perfect way to beat the biological clock, opponents have mainly ethical concerns. In theory, women could freeze their eggs at the age of 20 and have them implanted at the age of 54, which of course poses a health risk to the woman. The debate has been fuelled by Apple and Facebook announcing that they will cover the costs for their female employees to help them plan their careers. Pros and cons aside, "pregnancy on demand" is on the rise. Studies have shown that more and more women are taking advantage of this option, either because they want to advance their careers or because they do not yet have a steady partner. While only 22 women in Germany used this option in 2012, 134 did so a year later. As not all fertility centres report this treatment, the number of unreported cases is likely to be higher.

The legal side

In Germany, Switzerland and Austria, the handling of eggs and sperm is regulated by the Reproduction Act. Only a woman's own eggs can be used. Egg donation is prohibited. If eggs are not used, they must be destroyed, but they can also be used for research. If a woman decides to have her eggs fertilised, she will of course need sperm, and the sperm must come from her partner. Otherwise, sperm donation would be prohibited. Social freezing is not regulated by law.

The cost

It is good news that these methods are available, but they are not cheap. The egg collection alone costs around 5,000 euros. There are also annual storage costs of around 150 euros. If the woman later decides to have the eggs fertilised, there are additional costs that have to be paid privately. Even if there is a medical indication, patients have to pay the costs themselves, as egg collection is considered a preventive measure at this stage. In this context, it may be worth looking at neighbouring countries, especially Northern Cyprus, where costs are often lower. Here the cost of social freezing is around €2300, storage for the following year is around €250 and frozen embryo transfer (FET) costs between €1000 and €2000, depending on the clinic. It is possible to transport eggs, sperm and embryos from one clinic to another, provided the EU criteria are met and the transport is carried out in special containers with the utmost care. Ultimately, the possibility of family planning in this way is also a question of cost.