Is Egg Freezing Right for You?

There is no denying that egg freezing is a controversial topic. This has been much discussed in the Assisted Reproductive Technology (ART) world for some time now and with Apple and Facebook offering egg-freezing benefits for employees, the topic is under more scrutiny than ever. As a 27-year-old female ART attorney, this is of interest to me for more reasons than one. It is intriguing from a legal point of view, but it’s also a conversation about medical advances, social politics, business strategy, and moral interpretation. Our societal history divides women into two camps, those who have their career and those who have their children. What about the women who want the best of both worlds? Do we have to choose? Is egg freezing the solution?

Egg Freezing

 

Egg freezing preserves your fertility. Freezing eggs can give a woman the time she needs to focus on her career and achieve a level of success harder to attain otherwise. After all, statistics overwhelmingly demonstrate that most managerial and leadership positions are still held by men and childrearing and family building can negatively affect that opportunity for many women. Not to mention, some companies are now offering egg-freezing coverage for their employees so cost may not be as big of an issue.

 

Medically, this is also helpful for women whose health will impact their ability to produce eggs in the future. Women with cancer, for example, who have an expectation of chemotherapy, can freeze their eggs before treatment to retain the option of having a genetic child. The American Society of Reproductive Medicine (ASRM) considers egg-freezing an invaluable option for cancer patients. (see the ASRM Ethic Committee’s report on the effect of chemotherapy on fertility here.) This is an option for women with a strong family history of early menopause or premature ovarian failure.

 

Freezing eggs also provides one the ability to donate eggs to a woman who never had or has lost her ability to produce her own eggs. Egg donation is becoming increasingly popular and that is a direct result of the cryopreservation techniques for eggs used today. Unfertilized egg cryopreservation removes the necessity of a sperm contributor, medical costs, and medical risks associated with a fresh embryo transfer. Additionally, speaking from an ethical or perhaps religious perspective, some women rather freeze their eggs and not their embryos. They would argue the fertilized egg is a person and no longer just a gamete. Egg freezing allows preservation before “personhood” is achieved.

 

Conversely, there are many reasons to be skeptical of this technique and manner of preserving ones fertility. For starters, there is not a lot of research on the health or mental status of the resulting children. While ASRM removed the “experimental” label from egg freezing in 2012, they are not proponents of the technique for elective use. ASRM states there is “still not enough known about the egg freezing procedure’s safety, efficacy, cost-effectiveness, and emotional risks” and cautioned that it may “give women false hope”. The American College of Obstetricians and Gynecologists reported, “There are not yet sufficient data to recommend oocyte cryopreservation for the sole purpose of circumventing reproductive aging in healthy women.”

 

Additionally, as a clinic in California explains, there is the concern that not all eggs will survive the thawing process anyways and no guarantee that the woman will have a live birth from it. The age at which the egg is retrieved for cryopreservation is a large factor in the quality of the thawed egg. A Belgian bioethics report states “women tend to cryopreserve oocytes at an age that is suboptimal … in their late thirties – when both oocyte quantity and quality have already considerably diminished and success rates for eventually establishing a pregnancy are thus limited”. (See ASRM about diminishing egg quality here.)

 

In addition to not really being an insurance policy to having children later, there are also many health risks involved as well. New Republic states that some women have reported becoming infertile or experience early menopause after exposure to the drugs or have had retrievals that leave behind damaging scar tissue. The process is not by any means like retrieving sperm from a man; egg retrieval is a very intensive procedure and requires medication on top of an invasive surgery. Normally, a woman’s body produces one egg per cycle but, to freeze, a woman’s ovaries are stimulated to produce anywhere from 5-30 eggs (although 10-15 is common) for the retrieval. This stimulation can sometimes lead to Ovarian Hyper Stimulation Symptom and although the risk of it can be lowered there is always a risk. There can also be ovarian torsion and mental effects post treatment like depression and post traumatic stress disorder.

 

Lastly, the cost is huge down side to this procedure. Aside from paying approximately $500-$1000/month for storing the frozen eggs, there are costs associated with the procedure itself (approximately $10,000.00), the medications involved pre-retrieval and post-retrieval, the IVF procedure later on to become pregnant from the thawed eggs (approximately $5,000.00), and quite possibly the cost of having a surrogate carry the child if the woman cannot.

 

Overall, there are many things to think about when considering egg freezing but in the end, this is a woman’s individual choice. We are all different and only we can decide what our journey will be. What is important is that we do our research before making this decision. Informed medical consent is far from being everything necessary to know about this process and education on the matter is key. Don’t let comments like “take control of your biological clock” fool you; instead consider the facts and ask yourself, am I doing this because I have the luxury to, or because I need to? What am I giving up? Is this reproductive path a choice or a last resort?

The Truth About IVF & Multiples

iPhoto Library

About a month ago now, an anonymous father shared his disappointment and unhappiness at the upcoming birth of his twins via IVF on his Babble.com blog post for the world to see. See the CNN article here. He explained that he and his wife were “pissed. And terrified, and angry, and guilty, and regretful.” To say that they were upset at the prospect of having two healthy babies is an understatement. One commentator wrote, “…there are thousands of parents out there who would love to take them in. I’m not sure if I should feel [pity] or disgust.” Yet others sympathized with him at the hardship that raising twins will bring but nevertheless emphasizing the blessing it is in the end.

It is important to note that while IVF increases the chance of multiples, it is not as likely as one might believe. Today, increased success rates allow for the implantation of fewer embryos, which therefore result in less multiple births. However, like many of those who showed their support for the Babble Blogger parents, there is a misconception that persons using IVF will likely get pregnant with an unusually high number of children. Just last week I was at the beauty salon and two of the nail technicians were talking about how “dangerous” IVF was because you could get pregnant with EIGHT children. This idea has stuck in people’s minds due to the media coverage and popularization of people like Nadya Suleman (“Octomom”) and shows like John & Kate Plus Eight on TLC.

The truth is that although IVF has an increased chance of multiples, recent technology and practice limits it primarily to singletons or twins. Earlier this year, The Society for Assisted Reproductive Technology [SART] released it’s latest data which confirms that the number of live births resulting from IVF are going up, while the chances of having multiples is consistently going down.  SART’s national statistics show that for women between the ages of 35 and 37 undergoing IVF and using fresh embryos, 26.7% of them had live births resulting in twins, while only 1.3% of them had live births resulting in triplets or more. Those numbers go down to 14.9% and .7% for women ages 41 to 42 and with on-going medicals trials improving the success rates, the numbers continue to decrease. See Fertility and Sterility 100.3 (2013): 697-703 abstract here.

These same outcomes are reflected internationally as well. The European Society of Human Reproduction and Embryology reports that in 2010 the average number of embryos transferred per cycle was 1.75. Furthermore, a more recent trend is to only implant one embryo per transfer, this technique is referred to as a single embryo transfer or SET for short. The use of SETs is reflected in Europe’s low rates of multiple births. For example, Sweden has the lowest multiple delivery rates in the world right now and 73.3% of all transfers performed there were single embryo transfers. Due to higher success rates, this is a trend that is picking up speed in the United States as well.

Ultimately, just like a natural method of conceiving, it is hard to know for sure how many embryos will take before they actually do, but technology today gives us a really good idea. When you begin your journey, you and your doctor should have gone through all of the possible outcomes and make sure you are fully informed before making your decision. In the end, with the information available to you and the informed consent from your physician, the possibility of multiples should never be a complete surprise. Keep in mind however, that with single embryo transfers becoming more of the norm and technology advancing more and more everyday, that possibility is lower than you might expect.