Michael Grynberg, head of reproductive medicine at the Antoine Béclère hospital in Clamart, receives a 31-year-old woman in his office.
She has endometriosis, a condition where the uterus swells painfully. She’s been taking hormone treatments for the pain, which interrupted her fertility.
Three months ago she stopped the treatment to see what would happen.
“Your ovaries appear to be working normally again,” Grynberg tells her, looking through her file. He wants to take advantage of the situation to extract her eggs now before she goes back on the treatment.
They will then be frozen so she can use them in the future if she wants to have a baby. The woman sees this as a kind of insurance.
“I’m single, and I am not planning on having a child right now. For me it’s an ‘ideal’ solution,” she explains.
Grynberg reminds her that most women with endometriosis end up conceiving a child naturally.
Doctors in France are increasingly willing to freeze the eggs of patients suffering from endometriosis. But what about those who have no obvious medical problem, women who are worried they are getting too old to conceive naturally?
Grynberg calls this “social freezing”, which is not currently legal in France. So he tries to find a medical reason for these women, to stay within the law. “We are always trying to help these patients, to try to find something, if it exists," he explains.
He never makes anything up. “But if we find something, we can push it, to consider it a medical problem.”
The average age for a first pregnancy in France is 28.5 years old, up from 24 years old in the 1970s. And many first pregnancies happen when a woman is in her 30s.
“Women today postpone pregnancy,” says Grynberg. This can be for career reasons, or because they have not found the right partner. Also, families are changing: “More and more people divorce and want to have another kid with a new partner later in life.”
He can offer these women IVF, in-vitro fertilisation, a medically-assisted way of conceiving available to women in France in heterosexual couples. They can do this until the age of 43, but using their own eggs at the time they come in for the procedure.
This is problematic because a woman’s egg quality decreases dramatically after the age of 35.
Limits of technology
“We do not have any technique to improve the egg quality,” says Grynberg. The only medical tool available is to freeze a woman’s eggs when she is younger, to “fix time by freezing eggs”, as he puts it.
A woman over 36 years old has a 5 to 10 percent of conceiving a child through IVF. If she uses eggs that she froze before she was 35, her chances of conceiving a child go up to 60 percent
Grynberg is frustrated that he cannot offer the option to his patients. If older women are allowed to go through IVF, why not give them access to something that increases the chances of success?
The bioethics law currently making its way through the French legislature would legalise egg freezing for women, regardless of their medical condition.
Since 2011, the option has been available for those who have serious medical problems affecting fertility, like radiation treatments for cancer.
So Grynberg bends diagnoses, like endometriosis. The law gives him a lot of discretion.
“The law has been written in a way to enable the physician to consider what could be medical and non-medical. I consider this law as very permissive,” he says.
Pressure on women
The provision allowing egg freezing made it into the bioethics legislation with 39 votes, out of only 44 MPs who turned up. The legislation is now waiting to be read by the Senate in the spring, before it will become law.
Lawmakers arguing against allowing egg freezing raised concerns that companies would pressure women to put off having children and focus on their careers instead. They pointed to US tech companies covering the cost of egg freezing for their female employees.
As a result, the French legislation will have a specific provision prohibiting anyone – an individual or company - from paying for the procedure for anyone else.
For Grynberg, whose focus is on the medicine, the major issue with any fertility treatment is a lack of information in France.
Many of his patients come to him completely unaware of how much fertility is dependent on age.
“It's crazy the number of patients coming to my office saying, I thought that IVF or other medical techniques could help me, even if I'm 38, 39 or 40,” he says. “We need to improve the knowledge of this for all young women. Because they need to build their careers and lives with this knowledge.”
This story was produced for the Spotlight on France podcast.
