By Virginia Pelley
Valerie Landis was familiar with the process of oocyte cryopreservation, known informally as egg freezing and euphemistically as “fertility preservation.” After all, she’d been working in the women’s health and fertility space for most of her career. She first considered freezing her eggs at 28, but held off to work through a difficult relationship. When that ended, she set out to meet someone else. After three years of “endless blind dates,” she decided it was time to put her eggs on ice.
A growing number of women have made the same decision in recent years. Between 2009 and 2016, the annual number of egg freezing cycles in the U.S. climbed from 564 to 8,892, according to the Society for Assisted Reproductive Technology. Even since Landis launched her educational site Eggsperience in 2015 (she also has a podcast, Eggology Club), egg-freezing has become a more widely accepted practice, with celebrities openly giving it a go and tech industry leaders adding it to their employee benefits packages. Instagram ads targeting women in their 20s now portray freezing your eggs as a no-brainer for the modern millennial.
For women who want more control over their reproductive future, or know that they won’t have viable eggs for much longer, freezing can be an empowering choice, advocates say. But it can also be a much more expensive, speculative and emotionally taxing journey than women bargain for, and one that may make more sense to do when there’s a clear reason why, beyond just “why not?”
If you’re considering freezing your eggs, here’s what you should know.
What are the main reasons women freeze their eggs?
The general purpose of freezing your eggs is to preserve your ability to have children in the future. The procedure was developed in the 1980s for women who had a medical condition, or had to undergo medical treatment, that might leave them prematurely infertile.
In 2008, with the introduction of a more effective freezing technique called vitrification, elective or “social” egg freezing started to gain traction among healthy women who hadn’t yet found partners to have kids with or wanted to postpone parenthood for other personal reasons. And within the past few years, social egg freezing has seen even more pronounced growth, most notably among younger women opting to freeze their eggs years before fertility might become a concern. There’s also been an uptick in the number of transgender men freezing their eggs before they undergo gender confirmation surgery.
What does egg freezing actually entail?
From stimulation to egg retrieval, one round of egg freezing (known as a “cycle”) typically takes about two weeks. Here’s a breakdown of the process:
First, your doctor will perform a vaginal ultrasound to determine how easily they can retrieve your eggs. Then they’ll run blood tests to help them prescribe the proper dose of ovarian stimulating medication, as well as figure out how many eggs can realistically be frozen from one cycle.
Injections and monitoring (about 10 days)At the same times each day, you’ll inject fertility drugs (two at first, usually, and then a third one added after a week or so) into your stomach or thigh. The shots go right under the skin, like insulin injections. Instructions for the shots can be confusing, especially for first-timers. At one point, for example, you need to start using smaller needles, which some people forget to do.
The drugs, which may cause bloating, stimulate the ovaries to produce multiple eggs and then facilitate their maturation. Without this help, your body would only produce one egg (or more rarely, two) at a time.
During this period, you’ll also need to head to the clinic every two to four days. Each time, your doctor will check your blood hormone levels and do a pelvic ultrasound to measure follicle growth, meaning the rate at which the eggs are developing, and evaluate your body’s response to drugs.
Egg retrievalThirty-six hours before retrieval, you’ll give yourself a final “trigger shot,” which accelerates maturation of the eggs so they’ll be released at exactly the right time. The procedure itself, which is typically performed under twilight anesthesia, only takes about 20 minutes. Afterward, common side effects include spotting, cramping and nausea, but most women don’t need more than a day of recovery.
After the eggs are retrieved, an embryologist (a reproductive medicine expert) at the clinic freezes and stores them for however long you decide.
How are they frozen?
As of 2008, the preferred egg-freezing method is vitrification, which uses liquid nitrogen to “flash freeze” eggs in about 20 minutes. Before vitrification took over, doctors relied on slow freezing, which took two hours and allowed crystals to form while the eggs cooled. This was a problem, as those crystals could break during the thawing process, damaging the eggs’ internal structure and rendering them useless. With vitrification, there’s not enough time for crystals to form, giving the eggs a better chance of surviving the thaw and becoming successfully implanted embryos.
While vitrification has helped make eggs hardier, they’re still fragile compared to embryos, according to fertility specialists. This is why doctors usually advise women who have partners they plan to conceive with to freeze their embryos, not their eggs.
What’s the success rate for frozen eggs?
Even if an egg thaws without a problem, there’s no guarantee it will get fertilized and grow into an embryo, let alone become a baby — known as a “live birth” in fertility-speak. And compared to fresh donor eggs, it’s not clear how likely frozen eggs are to produce live births. Some recent research found similar live-birth rates for fresh and frozen eggs, but study results overall are mixed.
At this point, we just don’t know that much about pregnancy outcomes for frozen eggs. That’s due in part to egg-freezing being an expensive, relatively new procedure — it was considered experimental until 2012. While egg freezing has surged in popularity, the vast majority of women who’ve frozen their eggs haven’t tried to take them off ice and get pregnant. That means clinics don’t have much experience thawing and implanting frozen eggs. It also means experts only have very limited data to inform predictions about the likelihood of frozen eggs yielding healthy, full-term pregnancies.
In 2016, for example, doctors performed only 229 thaw cycles total for women ages 35 to 37 using their own frozen eggs. Of those women, 54.5 percent carried their babies to term,according to SART. As of 2015, fewer than 2,000 live births (total) were reported from egg freezing.
That data, and most data on pregnancy outcomes from egg-freezing, is limited in its applicability. It largely comes from older women, who made up the bulk of the egg-freezing population until recently. And it mostly concerns eggs frozen the old, pre-2008 way, or at a minimum lumps together old and new freezing methods. That’s not very helpful; to get an accurate sense of how likely pregnancies are to result from cryopreservation, you’d have to isolate only instances where vitrification was used. Recent research indicates that eggs frozen today have a 90 to 95 percent chance of surviving the thaw and then functioning as if it fresh.
Last year, a research team lead by doctors at Brigham and Women’s Hospital introduced a counseling tool to help doctors loosely predict patients’ live-birth outcomes from frozen eggs. Mark Trolice, a reproductive endocrinologist and infertility specialist in Winter Haven, Florida, says these models are “the best guide we have to provide patients with a reasonable expectation based on the number of mature eggs [they’ve] frozen.”
Still, in the end, your ability to have a full-term pregnancy using your own frozen eggs doesn’t solely depend on the eggs themselves. Regardless of how old your eggs are, the age at which you try to get pregnant matters too. “There are so many other medical issues, such as high blood pressure, diabetes and uterine fibroid, that are more common as women age and can affect chances of bringing a pregnancy to term,” said Shefali Shastri, a reproductive endocrinologist, ob-gyn and clinical assistant professor at Rutgers-Robert Wood Johnson Medical School in New Jersey.
Other factors that affect full-term pregnancy likelihood (using any eggs, frozen or fresh) include the age of the father (sperm-supplier), as well as the health of the uterine cavity and fallopian tubes,.
How long do I have to freeze my eggs?
There’s no official medical age limit for egg freezing, but here’s the reality: Women who freeze their eggs by age 34 appear to have better chances of live births than older women, according to a 2015 study. For the average woman, fertility declines slightly after 30 and then drops off dramatically between 35 and 37. While the most important fertility determinant is egg quality, quantity factors in as well. At birth, women have 1 to 2 million eggs. By age 37, that number falls to 25,000. The more eggs you freeze, the more chances you have to get pregnant using one.
“If you take 10 eggs from a 25 year old and 10 from a 45 year old, quantitatively you have the same number,” said Alan Penzias, an ob-gyn and reproductive endocrinology and infertility specialist, who’s also the surgical director of Boston IVF and an associate professor at Harvard Medical School. “But I would guess you’d get seven or eight quality eggs from the 25-year-old and one or two quality eggs from the 45-year-old.”
Some experts say that news of famous women getting pregnant at advanced ages — like Janet Jackson, who became a mom at 50 — contributes to misconceptions about the average reproductive lifespan, which many women overestimate.
Does that mean I should freeze my eggs as early as possible?
It depends on whom you ask. Because both egg quality and quantity decrease with age, doctors do sometimes recommend that women freeze their eggs before age 30. That’s the crux of the argument for social egg freezing. But while some doctors are on board with this growing trend, others are hesitant to endorse it.
For one thing, while eggs should theoretically last indefinitely once they’re frozen, we don’t actually know if that’s the case. Other doctors just don’t feel comfortable encouraging 20-something women to freeze their eggs without a reason. “It would be unethical to say every 25-year-old woman must freeze her eggs or she’s crazy,” Penzias said. “There’s no empirically great reason to freeze your eggs just because.”
Encouraging healthy women to freeze their eggs before age 30 is an unnecessary medicalization of women’s bodies, believes Kylie Baldwin, a senior lecturer and postdoctoral fellow in sociology at the Centre for Reproduction Research in the U.K., and lead author of a recent study about women’s reactions to the egg-freezing process.
“It’s often painful, even if someone’s doing it proactively, and certainly not enjoyable,” Baldwin said. “Why go through something like that when you can do it naturally?”
Of course, not all women can do it naturally. If you want to freeze your eggs and have a condition that affects your ovarian reserve, such as endometriosis or ovarian cysts, or need to undergo chemotherapy (which destroys eggs and the reason that cancer patients have been offered the option to freeze their eggs for decades), then you’d be better off doing it sooner than later, Shastri says.
But if there’s no medical reason to suspect you’ll have trouble conceiving when you’re ready to be pregnant, Shastri says it’s not practical to freeze your eggs at 25: “If I had daughters, I would tell them that if you hit 30 and are not in a relationship and don’t see a prospect, it would probably be a good time to freeze your eggs.”
Penzias agrees that 30 is a reasonable age to start seriously considering freezing your eggs if you know you want children. “I think it’d be good to take social pressure off and make you feel you have some control over your life,” he said. “As long as you’re not scared into it, but are doing it with intention.”
How much does it cost?
Unless you work at Google, Apple or Amazon, don’t assume your health insurance covers egg freezing, which costs around $5,000 or more per cycle — and it’s relatively common for women to do multiple cycles. There are also storage fees, which vary but typically run at least several hundred dollars a year.
Be wary of companies that offer monthly payment plans, because one cycle could end up costing you $15,000, which is way above market price.
Some clinics might offer to retrieve a set number of eggs for a flat fee or advertise a bundled cost that includes retrieval, thawing and embryo conversion, whether or not you use those services.
The cost of hormone medications will also dip into the thousands, putting the total cost of one round of egg freezing in the ballpark of $10,000, Trolice says, and if you ever decide to try and use the eggs, that process costs around $10,000 more. Fertility doctors can’t just put your thawed eggs back in; they need to be fertilized with an intracytoplasmic sperm injection, or ICSI, which is a type of IVF, or in vitro fertilization.
Many but not all clinics also charge a few hundred dollars for a consultation. “You shouldn’t have to pay $400 just to talk about whether [their clinic] is the right place for you,” Landis said.
Does it matter which clinic I use?
Yes. Do your homework before you choose where to freeze your eggs, as success rates vary from clinic to clinic. A clinic lab director might show you national statistics or research claiming frozen eggs are as good as fresh eggs, but don’t confuse national success rates or study findings with outcomes for an individual clinic.
Here are a few questions to ask the clinic director:
- Where will my eggs be stored, how much storage will cost and what safeguards there are against storage malfunction?
- How many live births have you produced, how many embryologists do you have on staff and how long have you (the clinic director) been working here?
- What’s your “embryo conversion rate”? (That’s the percentage of eggs they’ve successfully thawed and fertilized, both from women donating their own eggs and egg donors in their 20s.)
“These are questions people don’t think to ask,” Landis said. “Egg freezing is the easiest part of the whole process. Making an embryo and carrying that child to term, that’s the hard part.”
By the time I’m ready to thaw my eggs, will advanced technology make it easier to get (and stay) pregnant?
We don’t really know. In one recent study of how women felt after freezing their eggs, many participants said they expected to have access to more advanced technology by the time they’d be ready to thaw their eggs.
But this may be an instance where biology defies “disruption.”
“There’s reason to be hopeful, but women’s aging would overcome any sort of technological advances we’re seeing on the horizon, I would imagine,” Shastri said. In other words, researchers might learn a little more about how to improve egg thawing and embryo implantation in 10 years, but because you’ll be aging while that happens, any increase in success rates due to scientific advances would be canceled out by age-related factors that affect the ease of carrying a baby to term.
Is there anything else to consider before I start clinic-shopping?
When you go in to freeze your eggs, you’ll be asked to specify what you want to happen to your eggs in the event that you’re unable to use them due to illness or death. You can choose to have them destroyed or donate them to a family member if you’d like. You might want to do some legal research or even consult a health attorney before freezing.
Virginia Pelley, a freelance journalist in Tampa, Florida, has written for print and digital publications including TheAtlantic.com, MarieClaire.com, MensJournal.com, the Washington Post, Cosmopolitan and Oxygen.
Original link The Paper Gown – ZocDoc 14 December 2018: https://thepapergown.zocdoc.com/your-guide-to-freezing-your-eggs/