Egg Freezing

16-19 Egg Freezing

Reed Pence: Thousands of women of childbearing age receive a cancer diagnosis every year. Many of them who don’t have children but would like them someday may face treatments such as chemotherapy or radiation that put their fertility at risk. For them, technology offers some insurance. Embryo freezing has been an option for them for some time. But what about women who aren’t in a relationship yet and aren’t in a hurry to get into one? The last few years, they have more options, too. Today, egg freezing is no longer considered experimental.

Dr. Owen Davis: Egg freezing, I think, is increasingly common. The number of births from egg freezing, obviously not all are necessarily reported around the world, but certainly, it would number in the thousands of babies that have resulted from frozen eggs. Far fewer than the number of babies from IVF total, partly because the technology for freezing eggs effectively has really only come to its maximum potential in the last handful of years. But as it has become ready for prime time, because we now have technology where egg freezing probably makes it virtually as effective as using fresh eggs, more and more people are pursuing it for a variety of reasons, but primarily for fertility preservation.

Pence: Dr. Owen Davis is president of the American Society for Reproductive Medicine and a professor of reproductive medicine at the Weill Medical College of Cornell University. He says it’s taken some high-tech to make egg freezing practical.

Davis: The concern is that the formation of ice crystals in an egg can wreak havoc and could theoretically damage the structures that divide the chromosomes and therefore lead to genetic damage to the egg. The breakthrough, really, was this technique called vitrification, which is ultra-rapid freezing of the egg where the cell water is rapidly replaced with cryoprotectant chemicals. So rather than slowly replacing the cell water you fairly rapidly do this. And then because these chemicals that protect the egg are actually potentially very toxic if they linger, you have to freeze the egg very rapidly. So essentially the egg is plunged into liquid nitrogen. So it goes from room temperature to liquid nitrogen temperature instantaneously. The cooling rate is something like 30,000 degrees centigrade per minute to give you a sense.  

Pence: Under those conditions, Davis says frozen eggs may have survival rates of more than 90 percent when thawed. So women can now essentially reach back in time to retrieve their fertility, perhaps years later. But Davis says we might want to consider limitations to this technology.

Davis: The technology has gotten pretty good. I guess the biggest limitation now is what is the appropriate use of the technology? I think that most of us can agree that if you have somebody who is confronted with a diagnosis of cancer, for example, where she’s either going to have surgical removal of her ovaries or have chemotherapy or radiation therapy that’s going to basically result in a loss of all her eggs, the ability to preserve one’s potential to have a baby in the future by freezing her eggs certainly makes a lot of sense and any risk that might be assumed by going through any kind of medical treatment is probably justified. I think the area that’s a little bit trickier is what we call social egg freezing, which is a woman freezing her eggs at a younger age because she may want to have children at an older age where her fertility rate will be lower.

Rachel Lehmann-Haupt: Mother Nature does not want us to have kids when we’re older. And that is why women were given a biological clock.

Pence: That’s Rachel Lehmann-Haupt, an expert on the influence of technology on family life and author of In Her Own Sweet Time: Egg Freezing and the New Frontiers of Family.

Lehmann-Haupt: Our fertility does start to decline in our mid to late thirties. It’s definitely an individual thing for each woman. Your fertility doesn’t drop off a cliff; it’s a slow decline. By the time you hit your forties, it does become harder to have children naturally. Now we have a lot of reproductive technologies that are allowing us to push the boundaries on that and actually have children into our forties, including in-vitro fertilization. Also, many many more women are now getting their eggs frozen when they are in their younger thirties or mid-thirties, and then unfreezing them and using them in their forties. Now that number of babies born to frozen eggs is small and freezing your eggs still doesn’t guarantee a baby, but there is a whole new tool chest of modern choices that families have in terms of family planning that allow us to outsmart our biological clock and have children older. 

Pence: Today some experts say at least two-thirds of all egg freezing procedures are for those reasons – to give women better odds they can have a child at an older age. But some experts say that’s exactly what the American Society for Reproductive Medicine didn’t want when it cleared egg freezing for wider use. Dr. Marcy Darnovsky is executive director of the Center for Genetics and Society.

Dr. Marcy Darnovsky: When they announced that they were removing the experimental label from egg freezing, they were doing that for cancer patients, for women who might become infertile as a result of treatment of a cancer. The statement specifically says that it should not be interpreted as promoting social egg freezing. But despite that the marketing juggernaut kind of rolls right over all the cautions.     

Pence: Egg freezing at a relatively early age can considerably lengthen the runway of fertility. But even if a woman freezes her eggs at 30, it’s no guarantee that she’ll get pregnant using them at 41. A study in the Journal of the American Medical Association shows a live birth rate of 47 percent with frozen eggs. But Darnovsky says the viability rate of frozen eggs is only between two and 12 percent. And retrieving those eggs is not without risk.

Darnovsky: I’m so aware because of the work that I do about all the problems of egg freezing both for the women that take these very powerful hormones, that we know to be very troubling short-term side effects, and that we have suggestions might lead to very dangerous long-term side effects, that we just don’t know about because no one’s bothered to do the studies to find out. Right now it’s a shot in the dark. We know about some of the problems; we don’t quite know what the extent is and we are starting to get some sense that numbers of even short-term bad reactions are underestimated and underreported. The moderate and more serious reactions that count as ovarian hyperstimulation syndrome have been reported as occurring in anywhere between less than one percent and well over 10 percent of women, and that’s a huge variation.

Pence: Despite the questions, egg freezing is even becoming a corporate benefit for women, most notably at high-tech firms like Apple, Intel, or Facebook.

Cali Williams-Yost: What’s happening is the technology is meeting them where they are and saying, okay, you want to wait. Now we’re going to provide you with different ways to perhaps maintain your fertility.

Pence: Cali Williams-Yost is CEO and founder of the Flex Strategy Group, Work-Life Fit Incorporated.

Williams-Yost: Where this first started was in Silicon Valley where you had very tech-savvy young women who understood the technology existed and were coming to their employers and saying we want this. I have found that more and more organizations are aware that there’s a life cycle in terms of their value-talent and what they are able to contribute when and how. I think for each of us we have to figure out what that work-life fit is for us.

Pence: Sounds like a pretty good perk. Egg freezing can cost around $20,000, and most women have to pay it out of pocket to have the chance to build a career and have a family later. But Darnovsky doesn’t like it.

Darnovsky: I think it’s really unfortunate that companies are choosing to go down that road. They’re really encouraging women to take health risks that are unnecessary for most women. And they are also discouraging companies in lots of sectors from putting in place more family-friendly workplace policies that would also mean that women wouldn’t have to make these difficult choices. And then another thing we could say is that the whole problem of egg freezing is that it really is individualized, it’s an expensive and high-tech medical solution to what’s really a social problem that we should address the social policies.

Pence: Instead of offering egg freezing, Darnovsky says the industry should offer more paid parental leave, more flexible work hour policies, better daycare, and a chance to scale back the intensive expectation of hours on the job. In fact, she suggests that offering egg freezing as a corporate benefit might be disempowering, anti-feminist and coercive. The message from the company is, ‘we want you to put off having kids. We want you to work. And work a lot.’

Darnovsky: I think from the company’s point of view, egg freezing means that they don’t have to deal with demands on their employees that families do place. They want more from those people that they employ and the people they want to employ mostly want to do a good job, but there has to be limits on the workplace demands when they get in the way of people having a reasonable family life and reasonable personal life. When employees get the message that the company expects that they delay having a family they are going to be very sensitive to that message. So I can imagine an employee going to her supervisor and saying that they are going to have a child and need some parental leave and the supervisor saying, ‘Oh, you probably want to know about this egg freezing benefit that we have.” I think that very well could be experienced as pressure.  

Pence: But Williams-Yost and Lehmann-Haupt don’t see sinister intent.

Williams-Yost: The Silicon Valley companies I spoke with said they are coming to us; they’re telling us this is what we want. We have not come up with this on our own as a master plan to get the young women who work for us to delay their childbearing. It really was something that they were using to attract and retain talent because the talent wanted it.

Lehmann-Haupt: I think that to criticize a company for offering good health insurance is probably not the best interpretation of a company. You know, it’s interesting because many of the companies that are offering egg freezing on their health insurance plans also happen to have some of the most progressive family policies, including paid family leave, maternity leave. So I don’t think it’s coercing women.  

Pence: However, Williams-Yost says if a woman gets the message as coercive, she needs to think very hard about whether putting off children is really what she wants.

Williams-Yost: If you avail yourself of this benefit and you freeze your eggs, make sure you are continuing to keep your eye on the prize as to what you want for your life, because the one thing that does concern me is that you sort of freeze and forget it, and then all of a sudden years have gone by and you haven’t tried to connect with a partner, if that’s what you wanted, or you haven’t built a community of support around you in terms of friends. Because you’re going to need that if you decide to have a child with a partner or on your own. Make sure that if you take advantage of this benefit and if you do freeze your eggs, you are still trying to be aware of the life you want and build that so that ultimately when you do decide to unfreeze the embryos and try to have a child, you have the life that you had thought you would want and you haven’t just put that on hold.

Pence: It should certainly be no surprise that people take advantage of egg and embryo freezing to extend fertility. Because in an ideal world, family planning means getting pregnant when you want to as well as avoiding it when you don’t. You can find out more about all our guests on our website, radiohealthjournal.net. You’ll also find archives of our programs there, as well as on iTunes and Stitcher.

I’m Reed Pence.