What to consider before egg freezing

Image Credit: Karl-Ludwig Poggemann/Flickr

In 2014, Brigitte Adams appeared on the cover of Bloomberg Newsweek magazine. A full-body, black-and-white picture of the then 41-year-old served as the background for a big and bold pink headline: “Freeze Your Eggs, Free Your Career – A new fertility procedure gives women more chances in the quest to have it all.” A single and successful marketing director at a software company in Los Angeles, Adams represented the story of a growing number of women choosing to undergo a medical procedure called egg freezing.

As the name suggests, egg freezing consists of retrieving and cryogenically preserving women’s eggs. In the process, women undergo weeks of hormonal treatment to mature their eggs, after which a doctor collects them through a surgical procedure.  The eggs are frozen and saved for a future time, when the woman chooses to become pregnant (through In Vitro fertilization). The technology has become increasingly popular in recent years,  — even companies like Facebook and Apple started offering it as part of their female employees’ health benefits.  From 2009 to 2013, the number of procedures in the country jumped from around 500 to almost 5,000, according to the Society for Assisted Reproductive Technology. One particular east-coast clinic, EggBanxx, estimates that over 76,000 women will freeze their eggs in 2018.

There is, however, a growing concern regarding this popularization and the way the procedure is marketed to women. In big metropolitan areas, such as New York and Los Angeles, clinics like Eggbanxx host “egg freezing parties” to go through the FAQ’s of the procedure. In those gatherings, women enjoy a night out with lectures where often the final message includes the companies’ mottos: “take control of your fertility future”; “pause your biological clock”; “smart women freeze.”

The problem is that this message is misleading and fails to disclosure all factors women should consider before spending between $7,000 and $15,000 per cycle of egg removal. Egg freezing is a medical procedure that not only involves risks, but comes with no guarantees. With success rates that can vary tremendously according to the women’s age and the number of eggs retrieved, the technology is far from being a miraculous solution for stopping the biological clock. “This is not something that women should look at as an insurance policy that will work 100 percent of the times”, says Dr. Serena Dovey, a fertility expert at University of Colorado – Advanced Reproductive Medicine.

Back in 2012, when Brigitte Adams started her egg freezing process, that was precisely how she viewed the technology — as an insurance policy. She documented her journey in an open blog she named Eggsurance. Two years later, in her interview with Bloomberg, she was still optimistic about her decision: “Freezing my eggs bought me time and the possibility to have a child in the future. It’s not a sure thing, but a gamble I am willing to take.”

Egg freezing is not a new procedure. Since the 1980’s, doctors have been using it to try to preserve the fertility of patients whose diseases or treatments impair or severely diminish any chances of conceiving, such as cancer patients undergoing chemotherapy. Early freezing methods, however, were not reliable. Because eggs have high water concentration, the methods could not prevent the formation of crystals, which could fracture and damage the egg when it was thawed.  In recent years a new technique called vitrification has allowed for much better results, as it fast-freezes the eggs with liquid nitrogen.  In 2012, the American Society for Reproductive Medicine lifted the “experimental” label from egg freezing technologies, and the procedure became the procedure of choice among women who wanted to extend their fertility window.

Since then, in a phenomena doctors and the media call “social” or elective egg freezing,  some healthy women, who do not have medical conditions, have been choosing to reserve their eggs. “Unfortunately, people don’t realize that no matter how hard they work, their reproduction is declining as they get chronologically older and there is nothing they can do to stop that clock from ticking,” says Dr. Glenn Schattman, a fertility expert at Cornell University. Earlier this year, Schattman published an article in the February issue of Fertility and Sterility magazine called “A Healthy Dose of Reality for the Egg-Freezing Party” describing the need for the medical community to spread accurate information for patients who sometimes “believe that the reproductive fountain of youth is obtainable by freezing their eggs.”

The first important thing to get straight about egg freezing is that its success rates are directly related to a women’s age when she collects her eggs, not so much to when she uses them. Younger women have more and healthier eggs. After they turn 35, eggs become scarcer and more likely to have chromosomal problems. Think about the natural aging process. Normally, a healthy 30-year-old woman has 20 percent chance of naturally getting pregnant every month, while by age 40 her chances are less than 5 percent per cycle. Egg freezing follows the same logic.

Chances of pregnancy naturally decrease as women get older // Image Credit: Pixabay.

The chances that frozen eggs will yield a baby in the future are between 2-12%, according to the American Society of Reproductive Medicine. But the chances decline as a woman ages. “At the age of 32, the chance of having a baby per frozen egg is between 8 and 10 percent. If a woman has 20 frozen eggs, then she has a pretty good chance,” says Schattman. At 38 years-old, however, the chances of pregnancy are closer to 4 percent per egg, and it is more likely a woman will only get eight or 10 eggs at every retrieval cycle.

As much as some clinics portrait the process as a party, there is nothing fun about the retrieving procedure. In general, for every cycle of retrieval, a woman would receive 10-12 days of daily hormonal injections to cause a group of eggs to mature and develop. Some women experience nausea, mood swings, and even weight gain. During this time, they need to be available for daily blood exams and ultrasounds to track their response to the medicines. When enough eggs are mature, the patient undergoes a surgical procedure under anesthesia called transvaginal retrieval, in which doctors insert a needle and collect the eggs.

The potential health problems associated with egg retrieval include common risks related to any surgical procedure, like infections, and more specific issues such as ovarian hyperstimulation syndrome, a painful condition in which the excess of hormones causes the ovaries to swell. Still, there is no large longitudinal study on the potential impacts of these fertility treatments. “What we don’t have are the long term effects on young, fertile women, administrating hormones to their bodies to produce eggs,” says Rene Almeling, sociologist specialized in women’s studies and healthcare at Yale University.

Being aware of the risks and knowing the real chances of success involved in egg freezing allow women to make informed decisions regarding their health and avoid emotional frustrations. By knowing their real chances of future pregnancies, some people might decide to have a baby now, for example. “With anybody that is interested in egg freezing, I would talk about realistic possibilities of having a child from a frozen egg,” says Dr. Dovey. That does not necessarily mean discouraging anyone over 35 to do it, just setting realistic expectations.

Brigitte Adams was already 39 when she froze her eggs. Through one cycle of hormones, doctors were able to retrieve and store 11 viable eggs. Last year, she decided to use them to try to get pregnant. In her blog, she wrote. “ I finally acknowledged to myself that the chances of Mr. Right galloping up on a white horse and whisking me off to coupledom were about as likely as me getting pregnant naturally (about less than 1% at age 44).”

The process was not easy, though.  On December 12, when the 11 eggs were thawed, only nine remained viable. On December 13, they were fertilized with a donor’s sperm. Out of the six successfully fertilized eggs, however, only one survived. The embryo was frozen until February 23, while Adams was preparing her body with hormones for the implantation. In early March she posted the latest update on her page under the title “Please, don’t rely on frozen eggs”. In one paragraph, she recalled about the emotional moment she learned the embryo survived only 72 hours in her body. At age 44, she wrote, she had run out of options. Among the things she wishes she would have done differently, she listed retrieving more eggs, trying to freeze embryos at a younger age and “working less hours on shitty jobs”.

The cruel irony of egg freezing is that although older women are the ones who most seek the procedure it works best for younger women who need it the least. But there is a deeper issue in  Adams’ blogs.  If women are trying to reprogram their biological clocks to fit into work schedules, then perhaps there is more to discuss than the health aspects of egg freezing. The social freezing phenomena could be highlighting changes we need to make in our work structure. “We, as a society, especially in the United States, need to do a better job of making it possible for women in their 20s and 30s to succeed without feeling like a death blow in their careers if they decide to have children”, says Almeling. “Most developed countries have far more support in place for working parents- men and women alike. And in the US we chose to make this an individual problem.”

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