Should You Freeze Your Eggs?
If you’re of a certain age (read: 30 or over), chances are people are starting to freak you out about your fertility and, if you’re like us, perfect strangers may also be weighing in on the fact that you should freeze your eggs ASAP! No matter that we’re all trying to navigate tricky careers, manage our money for the betterment of our futures and figure out the whole till-death-do-us-part thing—time, and ovarian reserves, wait for no one, apparently. So, should we be freezing our eggs? If so, at what age? We did some digging to clarify the conflicting information we’ve heard. Here, everything you need to know about this daunting process.
Egg freezing refers to the process of oocyte cryopreservation, wherein a woman’s oocytes (eggs) are removed, frozen and stored until she is ready to have a baby. At that time, the eggs are thawed, fertilized and implanted into the uterus as embryos in a process called in vitro fertilization (IVF).
According to the American Society for Reproductive Medicine (ASRM), the first birth from frozen sperm took place in 1953, the first birth from a frozen embryo in 1984 and the first birth from a frozen egg in 1986. Though the oocyte cryopreservation process initially resulted in low success rates, the ASRM says that "modifications in methods over the past few years may be responsible for improved survival of cryopreserved mature oocytes." You can read about the science in great detail here.
In 2013, the ASRM and the Society for Assisted Reproductive Technology (SART) published a document stating that oocyte cryopreservation should no longer be considered experimental. The American College of Obstetricians and Gynecologists endorsed these findings, stating, "Oocyte cryopreservation, with appropriate counseling, is recommended for patients facing infertility due to chemotherapy or other gonadotoxic therapies. There are not yet sufficient data to recommend oocyte cryopreservation for the sole purpose of circumventing reproductive aging in healthy women. It is recommended that patients be thoroughly counseled about the current lack of data on efficacy, as well as the risks, costs and alternatives."
"Egg freezing was initially used to help women with cancer and other medical conditions that could lead to early menopause," says Michele Hakakha, MD, a board-certified obstetrician and gynecologist in Los Angeles. "Nowadays, many women are using it to delay childbirth due to later marriage, continuing education, career choices, etc."
This deferral of baby-making can bring about benefits for children and mothers, but it can also prove problematic. "Fertility in most women starts to drop off at about 35 and absolutely by age 40," Dr. Hakakha says. "Egg or embryo freezing is something to consider." Hal Danzer, MD, of the Southern California Reproductive Center adds, "On average, ovarian reserve begins to diminish at age 35." According to the American College of Obstetricians and Gynecologists, "Women with diminished ovarian reserve commonly have a reduced quantity of ovarian follicles and, thus, may have a limited response to ovarian stimulation with fertility medications and reduced probability of achieving a live birth in a single reproductive cycle." In other words, it can be harder to get pregnant naturally after 35, which is why many women who, for whatever reason, aren't quite ready to have a baby before then are opting to freeze their eggs to help ensure reproductive success later in life.
Another reason to freeze may be if you've started trying to conceive in your late 30s, or think delayed childbearing might be a possibility, and you want to have more than one child. You may be able to get pregnant with the first one naturally, but then there's two and three, at which point you could be well into your 40s. Of this point, Dr. Hakakha says, "This is so tough for women, and I hate having to tell them to plan ahead since men can have babies when they're in their 70s; however, if someone is 38, newly married (or not married at all) and wanting a big family (three or four children), egg freezing or, more appropriately in this situation, embryo freezing is something to seriously consider."
Though egg reserves generally don't begin to diminish until the age of 35, both doctors we spoke to suggested women freeze their eggs earlier, if possible. "The ideal time to freeze eggs would be in a woman's late 20s or early 30s," Dr. Hakakha advises. "Although there is never a 'too old' (because ovarian reserve varies so much from woman to woman), it is much more difficult and sometimes impossible to harvest eggs from women in their late 30s and early 40s."
A diminished ovarian reserve is one risk of waiting. Another? "At the age of 35, 65% of a woman's eggs are genetically balanced," says Dr. Danzer. "That number drops to one out of four or five after the age of 40." The takeaway? Younger eggs have a better chance of converting to healthy pregnancies, and even if you can get pregnant naturally over the age of 40, it's riskier than using younger eggs to conceive.
Dr. Danzer further cautions that the ovarian reserve in some women diminishes earlier than age 35, and though this is an extremely small demographic (2 to 3%), it can be wise to have your anti-Mullerian hormone tested once a year just in case. This test—which can give you a sense of the health of your ovarian reserve—is simple and can be done by your ob-gyn or at a local fertility center.
At the beginning of your cycle, you'll start injecting yourself ("under the skin, like Botox," Dr. Danzer says) with medications meant to stimulate your ovaries and prevent premature ovulation. This goes on for 8 to 14 days, and during that time you'll go in every couple of days for an ultrasound and blood work. Once your doctor determines your eggs are ready for retrieval, you'll visit the clinic or doctor's office for a 15 to 20 minute procedure. According to the Mayo Clinic, "A common approach is transvaginal ultrasound aspiration. An ultrasound probe is inserted into the vagina to identify the follicles. A needle is then guided through the vagina and into a follicle. A suction device connected to the needle is used to remove the egg from the follicle." You'll be sedated during this process and may experience some cramping thereafter.
If you're over 35 (or even younger), according to Dr. Danzer, there's a good chance you'll be encouraged to repeat this process two or three times in order to retrieve a desirable number of eggs.
Both Dr. Danzer and Dr. Hakakha assure us that freezing eggs poses no threat to the possibility of natural conception. Our next concern? We've heard horror stories about the hormone injections, but Dr. Danzer says the medications are natural and safe. Dr. Hakakha adds, "Women are being injected with gonadotropins [synthetic hormones that mimic those naturally made in a woman's brain]. Minor side effects include weight gain, bloating, mood swings and acne. These side effects, although bothersome, are only temporary."
There is, however, some risk of what's known as ovarian hyperstimulation syndrome, about which the ASRM says, "Women with OHSS have a large number of growing follicles along with high estradiol levels. This leads to fluid leaking into the abdomen (belly), which can cause bloating, nausea and swelling of the abdomen. When OHSS is severe, blood clots, shortness of breath, abdominal pain, dehydration and vomiting are possible. Rare deaths are reported." Dr. Hakaha adds, "Studies from Canada show that about one-third of women who undergo ovarian stimulation suffer mild OHSS. In a recent British study following close to 350 women, about 14 percent were hospitalized for OHSS after stimulation cycles gave more than 20 eggs."
We've also heard rumors that eggs cannot be frozen for long periods of time. Dr. Danzer says not enough long-term research has been done, but "everything points to the fact that eggs are usable 5 to 10 years after freezing."
Finally, Dr. Hakakha reminds us of a challenge many may not consider when weighing our options. "Let's not forget about the emotional risks of egg freezing. It can provide false hope to women. It may be empowering in the moment, but there is no guarantee of success and studies show that frozen embryos have greater success rates than frozen eggs. It's an even tougher decision for a woman to freeze an embryo, especially a young woman. Does she ask a friend to donate sperm? Use a sperm donor? Ask her current partner?" Yikes. Read about one woman's largely negative experience with egg freezing here (and, in the interest of balance, a positive review of the process here.)
This is the part of egg freezing no one talks about when they're insisting you do it (in the grocery-store checkout line, eating cupcakes at a baby shower, etc., ad infinitum). While the retrieval itself is not overly cumbersome, turning those eggs into babies can be. You can read about in vitro fertilization in great detail here.
Pregnancy achieved through this means can pose additional challenges. "To actually use one's eggs and become pregnant, a woman has to go through IVF," says Dr. Hakakha. "The egg needs to be fertilized with a sperm and the embryo replaced into the uterus. The most recent national summary available from the CDC indicates that 46.4% of all babies born via assisted reproductive technologies (ART) were high-risk twins, triplets or higher order births, and costs for their care far exceed one billion dollars a year. Though often downplayed in the media, additional risks linked to children born through ART include higher instances of preterm birth, low birth weight, stillbirth, neurological impairments like cerebral palsy and increased associated risks of up to 28 percent of certain birth anomalies, especially of the eyes, neck and heart."
First of all, it's worth noting that the bulk of women who freeze their eggs don't end up using them. "60% of women don't use their eggs," says Dr. Danzer. "Over half of the women get pregnant on their own." However, he reminds us, even if you're able to get pregnant naturally the first time around, you may want the younger eggs for later pregnancies.
With that said, success rates for IVF vary drastically by age. (There's that ticking clock, again.) In 2013, 40% of IVF cycles resulted in pregnancy for women under the age of 35. Meanwhile, just 4.2% resulted in live births for women over the age of 42. As NPR reports, there are prediction tests you can take to get a better sense of your odds before you commit the time, money and energy required to undergo IVF, but they are not, by any means, 100% accurate.
Costs for oocyte cryopreservation vary, but you can expect an average of $10,000 per cycle. (Remember, you may be encouraged to undergo two or three cycles). The procedure is around $7,000, and the medications are $2,500 to $3,500, according to Dr. Danzer. Storage costs $500 to $800 a year.
According to Forbes, a typical cycle of IVF (using fresh eggs) will end up costing close to $20k. It can take several cycles to achieve a successful pregnancy. Dr. Danzer tells us that for women aged 35 or 36, the average is a whopping four cycles, and of those on their fourth cycle, only half will achieve live birth.
Dr. Hakakha readily admits what we're all thinking. "Most women are not financially capable of freezing eggs in their late 20s or early 30s, and egg freezing is simply not in the mind-set of a woman this age," she says. "Most believe it's too premature—there's a lot of time left to find a partner and have a child."
Currently, only 15 states require insurance coverage for infertility treatments, and specific coverage laws vary by state. You can look up your options here. Dr. Danzer further advises looking into financial aid programs specific to egg freezing. Many are limited to those who must undergo the process due to medical conditions (e.g. cancer), but there are new programs cropping up all the time. He suggests starting with Advanced Reproductive Care (ARC), but you can look into additional options here.
Should insurance coverage and financing fail, we asked Dr. Hakakha what those of us who can't afford to freeze our eggs within the desired timeline can do. "It's important for women to remember that many things they do in their daily lives can impact their future fertility, and they should really strive to take care of themselves," she says. "Smoking, for example, has been strongly linked to poor egg quality and premature menopause. Not using condoms can lead to STD transmission and pelvic inflammatory disease, which can negatively impact fertility by causing scarring in the fallopian tubes. So, creating your own 'insurance policy' doesn't mean you have to immediately freeze eggs. But it should mean that you have a conversation with your gynecologist to make sure you are doing everything possible to maintain your health."