In March of 2018, the New York Times released an article titled “What Fertility Patients Should Know Abut Egg Freezing”.1 This piece was written right after a recent incident involving egg storage failures at two large fertility clinics in Cleveland and San Francisco. The article painted a not-so-rose-colored picture of social egg freezing, making it an interesting blog discussion.
Social Egg Freezing has been defined as elective oocyte cryopreservation, not for acute or imminent medical dangers, but rather as a guard against the natural age-related decline of fertility.2
Oocyte cryopreservation was initially created to help preserve fertility in young women about to start chemotherapy for cancer treatment. While the initial freezing process had issues, a new ‘flash freezing’ technique known as the vitrification method of oocyte cryopreservation was created, showing marked improvements in success rates. This method had become so reliable, that in January of 2013 the American Society of Reproductive Medicine (ASRM) announced this method of oocyte cryopreservation to no longer warrant the designation of ‘experimental’.3 As a result, the stage was now set for social egg freezing to become a reality.
In industrialized countries, childbearing has become increasingly more delayed over the past few decades, resulting in increased apparent infertility rates. Some studies have shown that the rate of infertility is approximately 6% at age 20 to 24, 16% at age 30 to 34 and 64% at age 40 to 44.7.4 Since more and more women are waiting untill their 30s to attempt to have their first child, many are facing difficulties in doing so.
Proponents of social egg freezing report many benefits to choosing this as a viable option for child planning. Some reported benefits include: allowing equal participation by women in employment, more time to choose a partner and to seek financially stability, and it may reduce the risk of genetic and chromosomal abnormalities as compared to conceiving later in life.5 Overall, it is reported by some that by freezing a woman’s eggs at a younger age, she can prolong her fertility potential and reduce some of the genetic complications of having a child at an advanced maternal age.
As far as success rates of oocyte cryopreservation leading to a live birth, it depends on a woman’s age and the number of eggs frozen. It has been reported that on average a mature thawed oocyte has about a 6.5% chance of leading to a live birth, meaning that you need about 15 eggs to get a baby.6 However, it also depends on the patient’s age and therefore when stratified, number of eggs needed can vary drastically. In fact, women at age 34 would need to freeze about 10 eggs to have a 75% chance of one birth, while to reach the same probability of live birth, women at age 37 would need to freeze 20 eggs and women at age 42 would need to freeze 61 eggs.4
Furthermore, in order to gather the number of eggs necessary for higher probability of having a child, a patient might require multiple oocyte retrieval attempts due to diminishing oocyte reserve. A younger woman at age 30, will have about 15–20 eggs that could be retrieved with each cycle, however by late thirties and early forties, she will have much less available.5 In fact, it is documented that up to 10% of women in their mid 30s are involuntarily sterile due to diminished ovarian reserve.2 Therefore, at higher ages, multiple hormone retrieval cycles are often needed to overcome this decreased reserve.
Finally, even more staggering is the fact that when all is said and done, only about 9% of women who underwent social egg freezing actually return to use their eggs.4 This low utilization rate has led to many fertility centers being inexperienced to the process of thawing and inseminating frozen eggs. It was reported that of the fertility centers in the U.S. that offer oocyte cryopreservation, over 50% of them have never successfully thawed and inseminated frozen eggs leading to a live birth thereafter.3
The overall cost of social egg freezing varies depending on the number of years eggs are stored and the number of retrieval cycles that are required. As stated above, these factors depend on at what age oocyte cryopreservation is attempted. In order to retrieve the eggs, the procedure costs about $10,000 to $17,000 per cycle, with many women doing between 1 and 4 cycles on average.7 Furthermore, women pay about $3,000 for 5 years of egg storage, about $3,400 to $6,800 for the unthawing and fertilization process, and about $2000 for the hormone medications.7 Therefore, while younger women may end up paying about $30K, older women might be looking at numbers as high as $60K.
Social egg freezing is not without its risks. The heavy amount of hormones needed puts patients at risk for ovarian hyperstimulation syndrome, with the mild form (bloating and abdominal discomfort) seen in 20-30% of women, and the more severe form occurring in about 1%, and rarely, enlarged ovaries may be at risk for torsion.4 Furthermore, egg retrieval is a procedure with inherent risks, including bleeding, infection, intraperitoneal injury, and risks associated with anesthesia. Finally, while freezing eggs at a younger age decreases the risk of chromosomal abnormalities for the egg itself, being pregnant at an older age has the same risks of advanced maternal age as conventional older pregnancies. This means increased risk of hypertension/preeclampsia, gestational diabetes, placenta previa, intrauterine growth restriction, preterm labor and, and need for cesarean section.4
With social egg freezing becoming more and more prevalent in the news and media, it has become increasingly more popular. Furthermore, the increased availability and utilization of these practices in order to delay childbearing in women has led to some companies such as Facebook, Apple, Intel, Citibank, and JP Morgan Chase to offer financial coverage for this procedure for their employees.8 In addition, active duty officers about to be deployed are also offered financial coverage through the US Department of Veterans Affairs.8
Critics of social egg freezing have stated that these measures are put in place in order to discourage women from having children at younger ages, thus keeping them in the workforce longer. Furthermore, it may cause employers to prefer this as their recommended plan for female employees, instead of focusing on better maternity leave policies and other resources for younger women.
Overall, the many risks, high costs, and low live-birth rates of social egg freezing may not be as widely discussed, and should be considered if this route is chosen. However, social egg freezing should not be seen as the only viable choice for women interested in delaying childbirth, as there are many other options available!
- Belluck, Pam. “What Fertility Patients Should Know Abut Egg Freezing”, com, March 13, 2018, https://www.nytimes.com/2018/03/13/health/eggs-freezing-storage-safety.html
- O’Brien Y., Martyn F., Glover L.E., Wingfield M.B. What women want? A scoping survey on women’s knowledge, attitudes and behaviours towards ovarian reserve testing and egg freezing (2017) European Journal of Obstetrics Gynecology and Reproductive Biology, 217 , pp. 71-76.
- Robertson J. Egg Freezing and Egg Banking: Empowerment and Alienation in Assisted Reproduction, Journal of Law and the Biosciences, 113–136, doi:10.1093/jlb/lsu002, Advance Access Publication 28 March 2014
- Saumet J, Petropanagos A, Buzaglo K, McMahon E, Warraich G, Mahutte N et al. 356-Egg Freezing for Age-Related Fertility Decline. Journal of Obstetrics and Gynaecology, Canada , Volume 40 , Issue 3 , 356 – 368
- Allahbadia G. Social Egg Freezing: Developing Countries Are Not Exempt The Journal of Obstetrics and Gynecology of India (July–August 2016) 66(4):213–217
- Cobo A., Garcia-Velasco J. Why All Women Should Freeze Their Eggs. Curr Opin Obstet Gynecol. June 2016, 28:206–210
- Rowan, K. “Is Freezing Your Eggs Worth the Cost?” Live Science. April 17, 2015. https://www.livescience.com/50519-is-freezing-your-eggs-worth-cost.html
- Ikhena-Abel D, Confino R, Shah N, Lawson A, Klock S, Robins J, Pavone M. Is Employer Coverage of Elective Egg Freezing Coercive?: a Survey of Medical Students’ Knowledge, Intentions, and Attitudes Towards Elective Egg Freezing and Employer Coverage. J Assist Reprod Genet (2017) 34:1035–1041