ALLAS.se, Sweden | 6 August 2019 | Text & Photo: Malin Aunsbjerg
Original version in Swedish
Translation to English (by Marie Granmar)
More and more Swedes are using the help of Russian fertility doctor Olga Zaytzeff, who provides baby guarantees to women up to the age of 51. Cilla Holm is one of them. After 10 unsuccessful pregnancy attempts in Scandinavia, she traveled to St. Petersburg and, with the help of egg donation, had little Liv. "Every day when I wake up I have to pinch my arm to be sure she is there," she says.
Every month over a hundred Swedish women visit Olga Zaytzeff's fertility clinic in St. Petersburg, Russia, to fulfill their dreams – to become mothers. Olga has become known as the miracle doctor who promises baby guarantees for women up to 51 years. She regularly travels to Sweden to hold seminars and each time the premises are filled by curious child-longing women and men who want to know more about Olga's methods.
The Swedish couples and single women who turn to the Russian clinic have often tried to become pregnant for a long time without success. Many have gone through a number of unsuccessful IVF attempts in Sweden and put their last hope to Olga Zaytzeff and her team.
"Treats with all the heart"
Olga has been working with fertility for 15 years and she explains that she inherited the sharp brain from her father, who is a professor, and the emotional side from her mother. It is important to have both in this profession, she says.
- I treat with the whole brain and the whole heart, she says, smiling.
The medical part is about optimizing, as far as possible, the conditions of the child-longing woman.
- If you have an appendectomy, it works well to do standard surgery on the majority. But when it comes to women's fertility, it is important to tailor the treatment to get a good result. If you do it right in every step, you can increase the chances by ten percent in each step, and in the end this can be a lot, she says.
“It is important to tailor the treatment to get a good result”
- The feeling of being successful is the best thing about my job, she explains, citing a recent example of a woman who had made six IVF attempts in her home country and was now expecting twins with her own eggs after the first attempt at Olga.
PGS testing improves the odds
In the past, the average age of the clinic's patients was as high as 45. Now it is slightly lower, as more and more people turn to the clinic at an earlier stage.
Some of the reasons for the good baby statistics, besides tailored treatments and many hours of work to optimize conditions, are partly that they can do PGS tests on embryos and that they have a large bank with donated eggs.
PGS is the abbreviation for "pre-implantation genetic screening" and means that before embryo transfer it is possible to check whether the embryo has an incorrect chromosome number. Chromosomal abnormalities increase with the woman's age and are the main reason why the embryo does not attach or develop properly. By choosing the embryos that are most likely to survive, you can reduce the time to become pregnant with IVF. In Sweden, PGS is not allowed.
With many unsuccessful IVF attempts behind you, one alternative might be to use donated eggs. That is to use an egg from another woman.
One who chose this route is Cilla Holm, who runs the podcast I Want Kids (Jag vill ha barn) and today lectures with Olga.
She had made five insemination attempts and was in her fifth IVF attempt when she attended one of Olga's seminars about egg donation.
- My first thought was that I didn't want to go to Russia or make an egg donation. But I gained a lot of confidence in Olga and learned more about fertility in the 90 minutes than I had done in a year and a half of treatments in Denmark.
Since it was not legal for single people in Sweden to try to have children on their own when Cilla made up her mind, she had to turn to Denmark instead. She was also 40 years old and when the law passed through April 1 in 2016 she was too old to get help from the Swedish public health service. The Danish doctors she talked to considered that her conditions were good as the AMH level was relatively high and the egg reserve looked good. Cilla got the recommendation to test insemination, and she had good hopes of becoming pregnant. But the hope was shattered for every failed attempt.
- In retrospect, I understand that even if you have many eggs, they can be useless. Trying to get pregnant when you are 40 is idiotic. But no one had told me that.
Cilla feels that she was cradled into false security. She thought the chances were good but they weren't.
Doctor Olga Zaytzeff mentions that many people are deceived by the fact that more and more Hollywood celebrities are getting pregnant at higher age, when they are 46, 47 years old, sometimes even 50. However, in most cases it is a matter of egg donation.
"Hard to give up their eggs"
Obviously, it can be a difficult transition for a pregnant longing woman to give up hope on her own eggs, Olga explains.
- She needs time to mourn. I have met many crying women who say they have been told "You are too old, you will never become a mother".
- They blame themselves for not being good enough, and that leaves deep marks. There is a prestige in having genetic children for some women. Abandoning this can be experienced as a failure.
Olga gives her patients facts about how the body and fertility work and tries to get them out of the process of blaming themselves. They can also talk to a therapist. Mentally preparing to move on with donation can take up to a year for some.
“It was an unreasonable grief that was about lying on the bathroom floor crying”
For Cilla Holm it took a few months. When the tenth attempt also failed, she took a time out and opened the door to a life without children.
- It was an unreasonable grief that was about lying on the bathroom floor crying, but I also realized that I wouldn't die if I didn't have children. Instead, I saw opportunities like traveling and moving abroad, which gave comfort.
But since she was curious about egg donation, she attended another seminar with Olga. And soon the ball was rolling.
- I thought; what is most important, to become a mother or to be a genetic mother? It turned out that it was not important to me to be a genetic mother at all. I had mixed up all the sorrows: Why did I wait too long? Why didn't I meet anyone to have children with? And after going through so many failed IVF attempts, you also feel like a failed person.
At Olga's clinic, a baby warranty is provided if you purchase a package of three egg donation trials. This means that if there is no child after the three attempts, eighty percent of the money will be returned. Such a package costs just over 230 000 SEK if the couple uses their own sperm. Embryo adoption packages where you buy already made embryos with both egg donor and sperm donor are cheaper.
Cilla Holm bought such a package. And in January 2018, she embarked on a flight to St. Petersburg with the feeling that this time it will succeed. An embryo was placed in Cilla and ten days later she sat at home in Stockholm in front of her laptop and updated her emails once a minute. And finally she got the message she was waiting for. She was pregnant. And Little Liv is now nine months old.
- Every day when I wake up I have to pinch my arm to be sure she is there. And the next thought goes to these two people, a Danish man and a Russian woman who selflessly gave parts of their bodies to me. My life has been given a higher dimension since I had a child with the help of donors. Today I have a much better patience and always look for the best in people.
Cilla wishes that more Swedish women would be willing to donate their eggs so that more people could be helped at home. As it looks now, there are year-long queuing times and there are no guidelines from the National Board of Health, they are expected to be completed during the autumn 2019.
For Olga Zaytzeff, it has taken a decade to build up a large network of donors in Russia. They are often younger women who want to do something good for the world and the requirement is that they already have children. They are carefully screened, explains Olga.
- They are driven by helping and do not only want quick money, she says.
The clinic pays about 14 000 SEK for a donation. The women also provide history of their health, family relationships, handwritten letters and photographs of themselves as little ones.
How late can you become a mother?
Where the upper age limit for egg donation should be set is difficult to assess, Olga says.
If a woman is 44 or 51 when she becomes a mother is not important out of a health perspective, as long as she is healthy. But Olga has noticed that the surroundings may have judgmental views on women raising children late in life.
“What is right and wrong? What right do you have to judge?”
She herself cannot understand why children of older mothers would be worse off? On the contrary, she believes that these mothers are extremely motivated, have a stable economy and are calm and mentally ready.
- If you are not in the target group, what do you know about what is right and wrong? What right do you have to judge? If I get that kind of comment in social media then I don't want to spend time discussing with them. I listen to knowledgeable experts and focus on my patients.
The struggle led to a grieving process
Olga, who is 39 years old, has two children herself and experience from one IVF round. She has also frozen unfertilized eggs.
But the trend that women in their 30ies freeze eggs to avoid feeling stress is doubtful.
- You put a lot of hope into it, but there is no guarantee. In fact, it is a pretty poor forecast, only five percent result in babies. It is better to get started and try to have children in your 30ies, she says.
Not to wait too long is the golden rule when it comes to fertility. But Olga is there for all those who for various reasons still wait for the last. Giving them an honest chance to become parents is what she is passionate about.
For Cilla, the happiness of becoming a parent has gone hand in hand with a parallel grieving process after all years of struggling. A positive side effect, on the other hand, has been that pregnancy made her more susceptible to love.
- I got needed help with my connection problems when I was pregnant. It became harder to beat yourself up with a life you cherish in your stomach. When I was in the fifth month, I met a man I would never have been interested in before. And now we have been together for a year. He is a huge part of Liv's life, says Cilla.
A new Swedish law eliminates the requirement for genetic linkage between one of the parents and the child. Since the turn of the year, it is therefore legal for couples and single women to have children with both donated sperm and eggs, so called double donation. Private clinics may also be authorized to make embryo donations. But there are long queues as there are no egg donors in Sweden. Guidelines from the National Board of Health, which authorize clinics to perform IVF with embryo donation, are expected to be completed during the autumn 2019.
Couples and single women who become pregnant through IVF treatment with their own germ cells can donate remaining embryos to someone else through embryo donation.
What is AMH level?
Anti-miller hormone, AMH, is measured to give a clue about the woman's egg reserve. The higher the number, the more eggs she has left. However, a low value does not mean that you have less chances of getting pregnant, as long as you have ovulation, according to a previous study. Nor does a high value need to show high fertility. There may be many eggs but the quality of them cannot be measured with the AMH level.
What is PGS Test?
Pre-implantation genetic screening, PGS, means that during IVF treatment it is possible to check whether the embryo has an incorrect chromosome number. Chromosomal abnormalities increase with the woman's age and are the main reason why the embryo does not attach or develop properly. By choosing the embryos that are most likely to survive, you can reduce the time to become pregnant with IVF. In Sweden, PGS testing is not allowed. But in countries such as Denmark, Spain, Russia and the United States this is allowed.
What is the age limit for IVF in Sweden?
In public health care the upper age limit for IVF is often between 38 and 40. Thus, one must have made all attempts before reaching the age. For men, the equivalent age is around 55. Many private clinics offer IVF for women up to 43 years.
Some county councils or regions have decided that IVF should be included in the care guarantee and then the waiting period is three months. In other county councils, where treatment is not covered by the care guarantee, the waiting time can be up to two years.
What do you get paid to donate eggs?
It differs between county councils. The basic idea is that the amount should not be so high that it can attract women to donate solely for the sake of money. Contact your university hospital if you want to donate eggs. Private clinics also receive egg donations. For example, at the Livio clinics, the compensation is 7 000 SEK for each donation except in the region Skåne where it is 11 800 SEK. At the Karolinska University Hospital in Stockholm, the remuneration is 5 900 SEK.