The Rise of Egg-Freezing in the Fertility World

You’d be forgiven for mistaking the egg-freezing advertisement for a women-only coworking space or a networking happy hour as you flicked through your feed. The ad might have shown a group of open-faced women in stylish button-downs and statement glasses toasting to one another’s good fortunes above a single phrase: “Preserve your options.”

Or perhaps it was a woman with curls that betray a certain amount of effort, her hands grabbing the zipper of her moto jacket, next to the command “Own your future.” We are Americans in 2018, and we are in the business of sales, and the best way to sell anyone anything is to tell them they need it and it is their right to have it — even if, as in this case, the “it” in question is eternal youth.

Welcome to the business of egg freezing. It seems like everyone — fictional characters on Freeform’s The Bold Type; celebrities, like Olivia Munn, Whitney Cummings, and Rita Ora; friends and coworkers — is investing.

It’s only been six years since the American Society for Reproductive Medicine (ASRM) lifted the “experimental” label from egg-freezing procedures (known formally as oocyte cryopreservation), which had been growing in number since the first live birth of a baby that had been an embryo on ice (also known as Zoe Leyland) in 1984. The New York Times has reported that more than 20,000 American women have elected to freeze their eggs — that number includes a 1,500 percent rise from 2009 to 2016, says the ASRM.

In one study, 50 percent of straight single women undergoing
elective egg freezing said they were doing it because of a lack
of a viable partner.

Another thing they say? More than 85 percent of these women have not yet attempted to thaw those
eggs and use them. Data is limited regarding live births resulting from frozen eggs, and it’s often combined with statistics on births from frozen donor eggs from women in their 20s, muddying the figures further. The marketing, of course, is crystal clear.

And it was quick to find their prime target, who all of a sudden looked up and was 30. And then 33. I have never known whether I wanted a child — I’m more likely to cross the street to get up close with a German shepherd who looks like a really good boy than to coo at even the most photogenic of babes. Not to mention that doing anything about parenthood other than daydreaming seems irresponsible. I am not dating anyone with whom I would have a child, and in terms of my own resources, getting pregnant right now would constitute a fiscal emergency. I’m not alone — in one study, 50 percent of straight single women undergoing elective egg freezing said they were doing it because of a lack of a viable partner. So not because of a grand plan to have it all and get ahead at work before having children, as those happy hour ads might suggest.

I can’t imagine little hands beating a percussive request for peanut butter without also envisioning the person across the table who can roll their eyes in response with me. And that person remains very much a mystery, which makes those kids even hazier. But I have always held, somewhere in my mind, a fleeting blur of them — a presumption that I will at least have the option of one day seeing them clearly. And at the thought that I won’t? Well, something in my throat tightens that won’t unkink no matter what I drink.

So what are the options for a woman who doesn’t know what she wants but is starting to approach a fertility decline so steep that the very absence of decision-making will be decision enough? Well, the now near-500 American fertility clinics are so glad you asked. Price fluctuates by clinic, but for anywhere from $4,000 to $9,000 per egg-freezing cycle, you can buy yourself a golden lottery ticket to the high-stakes jackpot of family. (For what it’s worth, these numbers are good compared to the $10,000 to $19,000 one cycle could run just a few years ago.)

Then there’s the cost of the hormone injections necessary for the process — usually about $3,000 — plus storage, which can add up to as much as $1,200 a year. And unless you work at one of those tech giants with an egg-freezing subsidy (Apple, Google, Facebook) or have an incredible health insurance plan, this is all coming out of your pocket.

It’s truly a lottery ticket that you’re ultimately investing in, with no assurance of future success. Although these fertility clinics have developed a great talent for freezing — and freezing ever-younger — eggs, they haven’t had much occasion for thawing. “We really don’t have the experience yet to support women doing this electively,” says Catherine Racowsky, a professor of obstetrics, gynecology, and reproductive biology and director of the IVF Laboratory at Brigham and Women’s Hospital in Boston. “Frankly, I would have been much happier to see [tech companies] establishing nurseries in all their buildings so that women can actually have their children on site, breastfeed them, go visit them during the day.”

The particular desperation of those yearning for a family are dark
waters, and fertility clinics are the lighthouse keepers.

And Racowsky’s not done with her reality check — this one comes with a science lesson: “In order for an egg to be fertilizable it has to be mature. On average, about 70 to 80 percent of eggs that are retrieved are mature. Not all mature eggs are fertilizable. And not all eggs that fertilize are capable of making embryos that can make a baby.” What exactly does that mean? A coin flip. “Even in the best candidates, one cycle is about a 50/50 chance that you’ll get a baby from it,” says Elizabeth Fino, a reproductive endocrinologist and infertility specialist at the NYU Langone Fertility Center in New York City. So whether you freeze your eggs at 25 or 35, there are no guarantees.

Except of course for that outlay of cash — not to mention time and emotion. “You have to go to the clinic almost every day for two weeks to have your blood taken and have an ultrasound done,” says Emily, who decided to freeze her eggs after getting divorced at 36. “And the shots really mess with you. You want to eat everything and gain weight; you cry about nothing. It affects your job, and you
can’t really travel.”

Fertility is often fraught with emotion, but the particular desperation of those yearning for a family are dark waters, and fertility clinics are the lighthouse keepers. The most important thing to understand about egg freezing is that, contrary to marketing, you are not freezing time. If one of your eggs is ultimately fertilized, it will have to be housed in a body, which will likely be yours. “You still need to find a balance of ‘When do I come back and do this?’” Fino says. “It’s fine to get pregnant late in your 30s and early 40s, but once you start pushing it to 45 to 50 or older, that’s a problem…. There are a lot of ethical things surrounding the question: Do we really want to be promoting that the new norm is ‘Wait until you’re 45 or 50’?”

All that said, if money is no object, Fino recommends you go for it. “I tell patients that if their medical insurance covers it or you have a third-party benefit plan that gives it to you, I think it’s a no-brainer to do it,” says Fino. “But the financial commitment is huge. And it might not work. What does that mean for you?”

For some, the thought of money — any amount of money — standing between them and a potential family is too great to bear. “I spent between 16 and 18 thousand dollars,” says Amanda, who also froze her eggs at 36. “I moved out of my apartment and into my parents’ house for a summer and raised about 10 grand to afford it. If you can manage it financially, I would do it, absolutely. I guess my answer to that might be different after I actually try to use my eggs, though. If they don’t work, that would be a tough pill to swallow.”

At most, egg freezing offers an extended runway to start preparing for
a baby — financially, emotionally.

And there are plenty of bitter pills to take. I talked to one 32-year-old woman whose father offered to foot the bill if she could fit the process into her busy schedule, but “every month at the time I should start the hormones, I’m in Europe for work.” She still hasn’t resolved to make the time. Another, about to turn 40, had a cache of 12 frozen eggs that she was ready to thaw; she took a cross-country trip to ask an ex-boyfriend if he would be the sperm donor. He said no, so she was preparing to start looking at anonymous donors.

One 39-year-old had frozen her eggs at 35 when she was dating her now husband, conceived a child naturally at 37, and was now, after several miscarriages, excitedly preparing to undergo the second half of IVF. Her doctor was “relieved” she had frozen her eggs at 35, she reported, because her chances at a successful pregnancy were better. Every single one of these women encouraged me to do it, and more than one used the phrase “peace of mind.”

It’s not peace of mind, though, not really. Your mind never stops. At most, egg freezing offers an extended runway to start preparing for a baby — financially, emotionally. It also offers the potential for huge loss — disappointment does not begin to cover what women whose frozen eggs fail must feel, after all the hormones and money and planning.

At some point, and the sooner in the process the better, the questions must be answered: Do I want to have a baby? Under what circumstances? At what cost? For me, under very specific circumstances involving an alternate life filled with peanut butter and shared eye rolls, the answer is yes, it would be worth the roll of the dice. I can see that. Which means I have some planning to do — and maybe some very careful budgeting ahead.

Just Chill: A Simple Hormone Glossary:

Anti-Müllerian Hormone (AMH): Emitted from follicles in the ovaries, it can help predict whether enough mature eggs will be produced for successful freezing. If a patient’s AMH level is under 1.0 nanograms per milliliter, she could have a “low ovarian reserve,” which means she may need multiple cycles or might not be a good candidate for freezing (though this is not an indicator of her ability to get pregnant naturally).

Follicle-Stimulating Hormone: The hormonal shot self-administered daily over 8 to 12 days into the belly or thigh (expect mood swings, water weight gain,
and soreness).

Vitrification: After eggs are collected, an embryologist attaches up to two of them at a time to plastic strips (called straws) and dips them in nitrogen. Once frozen, the straws are labeled, put in a sealed canister, and stored in a monitored nitrogen freezer to maintain temperature.

Source: Lisa C. Grossman Becht, MD, FACOG, Director of Egg Freezing and Oncofertility at Columbia University Fertility Center

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