In late 2014, when Apple and Facebook announced they would pay female employees for egg freezing, the lid seemed to be blown off a box of caution.
The decision was immediately debated for philosophical reasons, mainly over whether it was a message to you that career advancement was more important than parenthood.
An outspoken supporter of egg freezing and someone who did it herself, Sarah Elizabeth Richards, is the author of a new book, “Motherhood Rescheduled: The New Frontier of Egg Freezing and the Women Who Tried It.”
In a self-penned article, Richards says, “Between the ages of 36 and 38, I spent nearly $50,000 to freeze 70 eggs in the hope that they would help me have a family in my mid-40s, when my natural fertility is gone.
“For this baby insurance, I obliterated my savings and used up the money my parents had set aside for a wedding. It was the best investment I ever made.” Whether you would make the same claim is, well, debatable.
Her claim is based on the “gender equalization” that egg freezing affords women by giving them control over when they have children.
But lost in the weeds is the fact that organizations whose focus is reproduction see some medical downsides that are seemingly being ignored. It’s really a good news/bad news issue and a matter of which you want first.
Starting with the good news, the American Society of Reproductive Medicine (ASRM) says egg freezing should no longer be considered experimental and “is a valid technique for young women for whom it is medically indicated.” This was after reviewing 981 small studies.
The American College of Obstetricians and Gynecologists endorsed the ASRM position, emphasizing that women should not rely on the procedure “for the sole purpose of circumventing reproductive aging.”
The bad news, as far as the ASRM was concerned, was that only 112 of those studies also looked at safety and effectiveness.
“We cannot at this time endorse its widespread elective use to delay childbearing,” the statement continued, which was based on a lack of medical evidence and the possible emotional toll an unsuccessful procedure could exact. “Marketing this technology for the purpose of deferring childbearing may give women false hope,” the ASRM said.
That’s the essence of the ongoing debate. For many years, the procedure was used primarily in women with cancer whose treatment could leave them infertile. But a cocktail composed of the Apple and Facebook offer, with a splash of “Lean In,” the best-selling book by Sheryl Stanberg on the lack of women in leadership roles, has given egg freezing a certain cache.
Stanberg’s book lends authoritative credence to the long-held belief that you are held back in business by “opting out” as your career kicks into high gear but you want to have a family.
In one of the first of its kind, a business called EggBanxx markets egg freezing directly to you at high-end hotel meetings. Its slogan is, “Lean in. But freeze first.”
“Commerce, the absence of data and fear is a pretty toxic mix,” Arthur Caplan, director of New York University’s Division of Medical Ethics, told the Washington Post. “Companies that sell this procedure are not held accountable to whether or not you have a baby. You’ve paid your fees…. There is optimism based on very, very little hard data. And it will take years and years for us to get that data.”
The University of Southern California (USC) fertility program, though, reports that about 5,000 babies have been born from frozen eggs in the U.S.
It adds that the largest published study of more than 900 babies from frozen eggs showed no birth defects, although USC Fertility allows that “it will take many years of follow-up to ensure that babies born from egg freezing technology have no higher rates of birth defects than those conceived through other means.”
Writing on a website, Renee Matthews, MD, took an unblinking look at this rising trend. “The biggest con is there is no guarantee that once the eggs are thawed, implantation will be successful and (will) result in the birth of a healthy baby.”
“Egg preservation is not covered by insurance because it is considered to be an elective procedure,” she added. “Currently, it can cost thousands to tens of thousands of dollars to freeze your eggs, thaw the eggs and finally implant them in your uterus.”
Most people do not have success on the first round of implantation, she adds, so the costs rise incrementally.
Although age range of fertility is different from woman to woman, freezing eggs before age 40 – when fertility starts to rapidly decline – is prudent for the odds of giving birth to be in your favor. Many reproductive experts say the ideal age is in the early 30s.
“The earlier the better,” says Briana Ruddick, MD, of the Columbia University Center for Women’s Reproductive Care. “You need to balance the chance of meeting someone and where you are in your career with the likelihood of getting pregnant by a certain age. I think young 30s makes the most sense because so much can happen between your 20s and your 30s.”
“All women who want to one day have a baby should think about doing it. I don’t care what you do for a living. Your biology is probably not as flexible as your career,” Ruddick adds. “I would have frozen my eggs if I hadn’t had a baby by the age of 35…. It’s not a guarantee. But at least it’s a chance.”
July 31, 2015
Christopher Nystuen, MD, MBA