Advertising has a long history of targeting people with fantastic promises. From the perfect cream that will zap wrinkles before they even form to the workout gadget that will tone your entire body in 10 days, we are told of problems we didn’t know we had—and the solutions we need to solve them.
Lately, marketers are delivering anxiety-provoking messages about fertility to young women who may not yet have put much thought into when (and if) they want to become mothers. Women are being urged to freeze their eggs while they are young, rather than waiting until those eggs are near or past their expiration date. Boutique fertility practices extolling the benefits of egg freezing are popping up around the country. A New York City-based clinic even has a mobile van women can climb aboard to take a blood test to help gauge fertility.
Also known as oocyte cryopreservation, egg freezing involves harvesting a woman’s eggs and freezing them so she can attempt pregnancy at a later date through in vitro fertilization (IVF).
Having the option to freeze eggs can be a valuable, life-changing one for some women. But Yale Medicine Fertility Center physicians caution that this option may not be appropriate for everyone, especially because egg freezing is by no means a simple procedure, and it does not promise pregnancy down the road. They urge women not to jump into the decision or feel pressured to put their eggs on ice without careful consideration of their health and their reproductive goals, as well as the egg-freezing process and cost, among many other factors.
“I applaud the idea of providing women with information about their fertility, as there is a profound misconception about the biological clock. Many don’t realize just how much their fertility declines with age,” says Pasquale Patrizio, MD, director of Yale Medicine’s In Vitro Fertilization, Fertility Preservation, and Male Fertility programs. “But I do not support the idea that there is one test you can do to check your fertility. There are multiple tests to assess a woman’s fertility, which should be taken into account with a full medical history. All of this should be done with a reproductive endocrinologist.”
Deciding whether or not to freeze your eggs requires a long conversation between doctor and patient, Dr. Patrizio adds.
“If you don’t have premature ovarian insufficiency (loss of normal ovarian function before age 40) or other risk factors that affect your fertility, you are going to be fine until your early 30s. You don’t need to worry about freezing your eggs if you want to have one or two kids,” Dr. Patrizio says. “However, if you are 25 and you want to have five children and you can’t start your family for another 10 years because you are so busy, then that is a different conversation. It should all be individualized and tailored to the patient.”
The rise of ‘social’ egg freezing
Though egg freezing is not a new procedure, a technology called vitrification has vastly improved the success rates of egg thawing and survival. Plus, in 2012, the experimental label was removed from egg freezing in the United States, which led to a surge in the number of women opting to undergo the procedure. In 2009, 475 women froze their eggs, according to the Society for Assisted Reproductive Technology (SART). By 2016, that number was 7,276.
That figure, however, does not differentiate between women who freeze their eggs for what are called “social” or “elective” reasons and those that are “medically necessary.” An example of the latter situation would be a young woman who is diagnosed with cancer and is about to start chemotherapy, which can affect her future fertility. (A man with cancer or another serious medical condition can opt to do the same with his sperm.)
Both situations (elective and medically necessary) are a form of fertility preservation (the removal and freezing of eggs and sperm). In Connecticut and a handful of other states, laws mandate that insurance carriers cover fertility preservation—for certain age groups—if deemed medically necessary because of a cancer diagnosis.
The cost of freezing eggs
Very few companies pay for elective egg freezing for nonmedical reasons as part of their health plans, so most (or likely all) freezing egg costs must be paid out-of-pocket. In addition to being expensive, egg freezing can also be uncomfortable and inconvenient. A woman needs to take injectable medicines to stimulate egg production for 10 to 12 days, and to have repeated blood tests and ultrasounds. Finally, the eggs need to be retrieved during an in-office procedure. All of this can cost up to between $6,000 and $10,000, or even more.
And if this process, or egg freezing "cycle,” doesn’t produce enough mature eggs, it will require another round—and another bill. Plus, there’s the cost of storing frozen eggs, which starts at about $600 per year. And when a woman is ready to thaw her eggs and attempt pregnancy, she’ll need IVF. That means fertilizing the eggs with sperm, growing an embryo, screening for genetic abnormalities (if the patient wishes), and finally implanting one or more of the available embryos into the womb. This, on average, could cost up to an additional $18,000.
Still, for some women, that money is well spent, says Lubna Pal, MBBS (a medical degree awarded outside the U.S.), MS, a reproductive endocrinologist and infertility (REI) specialist. Also, there is another fertility preservation option—embryo freezing—that has even higher success rates, notes Dr. Pal, who directs the Polycystic Ovary Syndrome and Menopause programs. (The embryo would be created via IVF and instead of implanting it immediately, it would be frozen until the time is right.)
Success rates aren’t known
It’s important to realize, however, that neither procedure—freezing your eggs or embryos—guarantees a future pregnancy. In the best of circumstances, IVF only works about 50 percent of the time, and using frozen eggs may bring those odds even lower, Dr. Patrizio says. Success highly depends on the age of the woman when she froze her eggs, and there is currently little data on how many women have actually followed through, thawing their eggs and attempting pregnancy. Some studies show the rates of usage for frozen eggs range from about 3 to 9 percent.
Amanda N. Kallen, MD, an REI specialist and director of the Recurrent Pregnancy Loss Program, says she reminds women that egg freezing is an imperfect technology. “I don’t want them to think of it as something they can do to delay starting a family more than they otherwise would,” Dr. Kallen says. “You aren’t guaranteed that you’ll be able to use those eggs when you freeze them.”
The fact that egg and embryo freezing are options for women doesn’t mean it’s something every woman unsure of whether she will want children in the future should pursue, Dr. Pal says. “Just because my insurance covers a hip replacement does not mean that I should get one, just in case my own hip gives me a problem,” she says. She feels it is important for women to reflect on their personal and reproductive goals and to discuss issues related to reproductive wellness with their physicians well in advance of planning for these procedures. She also notes that “the ability to freeze eggs does not give providers the license to push it.”
Stephen Collins, MD, PhD, a fellow REI specialist, agrees.
“I believe it is a valuable service for women who have a genuine desire to delay building a family. Maybe they aren’t with a partner or it’s not the right time with their education or career,” Dr. Collins says, “but there shouldn’t be fearmongering around it.”
Framing the fertility conversation
According to Drs. Collins and Pal, more women today ask about elective egg freezing, and the topic requires a thoughtful discussion. Barring any medical condition in which it is known that a woman is likely to experience fertility problems (endometriosis, diminished ovarian reserve, or a family history such as a mother who went through menopause early in life), the decision of whether or not to freeze eggs—and when—is not always clear-cut.
“My counsel to women is that if they know their career or the PhD they want to get or some other factor will prohibit them from starting a family until age 34-plus, then egg freezing is maybe something to consider,” Dr. Collins says.
Ultimately, whether or not to pursue egg freezing is a complicated decision, Dr. Patrizio says.
“It varies from patient to patient with many points to consider,” he says. “For example, a woman needs to consider if she would ever consider being a single mother in the future. If she is 40 and hasn’t found the right partner, would she thaw the eggs that she froze and use donor sperm?”
The choice is both medical and personal, Dr. Patrizio says, and not one that should be influenced by peer pressure or marketing campaigns.