Should I Freeze My Eggs to Extend My Fertility?

 

What to Know Before Making the Decision to Freeze Your Eggs

Whether or not you should freeze yo

ur eggs in your 30s or 20s—in order to defer having children until you’re older—is a controversial but important issue in the world of fertility. While your OB/GYN may bring up your biological clock and the importance of not delaying childbearing, your doctor is unlikely to mention the egg freezing option. There’s a reason for that. Not because egg freezing is a bad choice, but because it is a complex one.

If you’re considering egg freezing, you should know exactly what egg freezing can and can’t do for you, what the egg freezing process entails, your options if you choose to freeze (or not); and the risks, success rates, and costs of the procedure. Egg freezing can be a promising option for some, but it’s not a decision to take lightly.

What Is Social (or Elective) Egg Freezing?
To understand social (or elective) egg freezing, you need to understand normal ovarian aging. A person with ovaries is born with all the eggs they will ever have. With age, the number of eggs in the ovary naturally decreases.

This process of ovarian aging begins before birth. A 20-week old female fetus has between 6 and 7 million eggs in her ovaries. When that baby is born, the number has already decreased to just over 1 million. This is very different from males, whose reproductive systems (post-puberty) create an estimated 250 million new sperm cells daily. The ovaries cannot produce new eggs.

Male fertility also declines with age, just not as rapidly and dramatically as it does in women.

As you get older, eggs decrease not only in quantity but also in quality. This is why there is a higher risk of miscarriage for a 37-year-old compared to a 27-year-old.

Ideally, from a purely biological perspective, if a person with ovaries wants to have genetically related children, they should start trying to have those kids before age 35. Before age 30 is even better. But many people are not ready, able, or prepared to have kids by 30.

This is where elective egg freezing comes in. If, for example, a 30-year-old knows they don’t want to or can’t start having kids for another ten years, they can choose to have some eggs cryopreserved.

Later, they can try to get pregnant the regular way. If they conceive on their own, great! However, if they struggle to get pregnant, a fertility specialist can take those frozen eggs and use them to (hopefully) help them conceive via IVF treatment.

The cryopreserved eggs will be of higher quality than any eggs retrieved 10 or more years later. Those frozen “younger” eggs will be more likely to become fertilized, more likely to produce healthier embryos, and more likely to lead to clinical pregnancy and live birth. In some ways, it’s like becoming an egg donor—to your future self. But you can’t go back to that egg donor and get more eggs once they are gone. You only have what you froze years before.

Why Is Elective Egg Freezing an Option Now, When It Wasn’t Before?
Elective “fertility preservation” is new, but egg freezing is not. Egg freezing for medical reasons has been around for decades. The first live birth resulting from a formerly cryopreserved egg occurred in 1986.

Until recently, egg freezing was restricted to medical indications only. Medical reasons include:

Pre-cancer treatment (some cancer treatments damage the ovaries)
Family history or genetic condition that may cause premature ovarian failure (also known as primary ovarian insufficiency)
During conventional IVF treatment, if for whatever reason sperm is not available on the day of retrieval, eggs may be cryopreserved.
Earlier egg freezing methods were less successful. They used a “slow-freeze” process that sometimes formed ice crystals in the eggs. The ice crystals damaged the eggs and made them unusable. This was better than nothing for those with medical problems, since the only other option was to have no chance and no eggs.

Then, a new method of egg freezing was developed. Known as vitrification, this super-quick freezing process doesn’t allow ice crystals to form. Eggs cryopreserved with vitrification have a much better survival rate. In other words, they are more likely to get through the freezing, thawing, and fertilization process than slow-frozen eggs.

At first, vitrification of eggs was considered experimental. Then, in 2012, the American Society for Reproductive Medicine (ASRM) removed the experimental label. While the ASRM doesn’t recommend marketing egg freezing for the purposes of delaying childbearing, the removal of the experimental label led some fertility clinics to start offering elective egg freezing.

Vitrification for Egg, Sperm, and Embryo Freezing
Why Choose to Freeze Eggs for Non-Medical Reasons?
The most common reasons to choose elective egg freezing include:

• Not having found the right partner (this is the number one reason, according to the research)
• Career or educational goals
• Lifestyle or travel plans
• Ethical issues with embryo (in other words, they have a partner and could freeze embryos, but prefer not to)

rsonally and professionally, I definitely think that egg freezing is a great idea for anyone who is considering having children in the future but is not currently interested or able to conceive now,” says Diana Chavkin, MD, a board-certified fertility specialist who currently sees patients for egg freezing/fertility preservation and infertility at HRC Fertility in Los Angeles. Dr. Chavkin has used her expertise to help develop fertility preservation programs across the country, and she has helped hundreds of women through the egg freezing process since 2009.

On a personal note, I convinced my sister and helped my best friend to freeze their eggs,” shares Dr. Chavkin. “It is definitely something that I’d do myself. In fact, I had to do IVF to have my 1-year-old child, and at the time that I was having a difficult time getting pregnant, I wished that I had frozen my eggs years before.” (The current more successful egg freezing techniques were not available when Dr. Chavkin was of age to freeze her eggs.)

The Limits of Egg Freezing: Is It Really “Fertility Insurance?”

While Dr. Chavkin encourages cryopreservation to women needing to delay childbearing, she is careful to explain that egg freezing doesn’t give you the same fertility you would have had if you tried to get pregnant naturally at the time you froze your eggs.

“Egg freezing does not give you the same chances as you would have if you were having sex at that age,” says Dr. Chavkin. “Your best chance of trying to get pregnant is trying right now. But we know it will improve your chances if you plan on having a baby later if you freeze now.”

Sometimes egg freezing is advertised as “freezing your fertility in time” or referred to as a kind of “fertility insurance.” This is somewhat misleading. “With life insurance, when you die, there is a payment,” explains Dr. Chavkin. “When you freeze your eggs, there is no guarantee.” What egg freezing does offer is another option and the possibility of a better chance at conception, if you’re not able to conceive with your own eggs in the future.

What Are the Success Rates for Egg Freezing?
There is a misconception that one frozen egg is equal to one menstrual cycle. Therefore, you might think that freezing 12 eggs at age 33 will give you a “year’s worth of fertility,” like you would have had at age 33—but that’s not true.

There’s a lot of room for failure when you’re freezing eggs. The egg must:

• Survive the freezing process
• Survive the thawing process
• Successfully fertilize in the lab
• Develop into a healthy embryo in the lab
• Successfully transfer to the uterus
• Result in a clinical pregnancy (that is, a pregnancy confirmed with a heartbeat found via ultrasound)
• Lead to a live birth months later

According to the research, 2% to 12% of frozen eggs will result in a live birth.

This is not the same as the live birth rate per total number of eggs banked, which is higher. What are the chances that your frozen eggs will lead to one baby?

One study found that women who froze 8 or more eggs before age 35 had a 40.8% chance of live birth resulting from those eggs (possibly over many embryo transfer attempts). In this same study, women over the age of 35 who froze eight eggs had a 19.9% chance of live birth.

This is why it’s best to freeze several eggs. The general recommendation is that 8 to 15 eggs be frozen for women age 35 or younger. For women over 35 years old, the decision of how many eggs to freeze needs to be determined on an individual basis.

You may need to go through a few cycles to get a good amount to bank. How many cycles you’ll need depends on how your body reacts to the fertility drugs, your age at the time of freezing, your ovarian reserves, and the skill of your physician. More cycles mean increased costs.

It’s also important to be aware that your doctors don’t know much about the eggs that they freeze. They only know if they are mature enough for freezing—nothing else about their quality (and therefore chances of success) until they are thawed and used.

What Is the Ideal Age to Freeze Your Eggs?
Determining the ideal age to freeze your eggs is complicated. On the one hand, the younger you are when you freeze your eggs, the more likely you’ll have success with those eggs. On the other hand, you’re less likely to need them.

“You want to find the sweet spot,” explains Dr. Chavkin. “You don’t want to have all these women go through all these procedures, and then not use them, but at the same time, you don’t want to wait until a woman is older, like 40 years old, and wants to use her eggs, but not have a good chance of getting a good quantity or quality of eggs.”

If you’re looking for that sweet spot, it’s likely early to mid-30s. Be aware that at this time, there is a chance you will need multiple cycles to get a decent amount of eggs to cryopreserve. That means higher cost and more exposure to fertility drugs.

Is It Ever Too Late to Freeze Your Eggs?
The older you are, the less likely the eggs retrieved will be of high enough quality to lead to a successful birth. It may also be difficult to retrieve enough eggs (or any at all) to freeze. Many egg-freezing centers have age cutoffs somewhere between ages 40 and 45. That said, a part of egg freezing is ovarian reserve testing. This is done before the decision to freeze.

“The woman who upon evaluation is found to have low ovarian reserve may choose not to proceed with egg freezing after learning that the chance of getting a good number of healthy eggs is very low,” says Dr. Chavkin. “[However,] an older woman, late 30’s/early 40’s, could still freeze her eggs, but it may take more stimulation cycles to get the same number of eggs as a woman who is younger.”

What’s Involved in Freezing Your Eggs?
Egg freezing isn’t a 1-day or even 1-week event. It’s important you understand all that’s involved before you decide to go through the egg freezing process. Here is a brief summary of what to expect:

• Consultation appointments, possibly a few, with the doctor, before making the decision
• A number of fertility tests, blood work, and ultrasound to evaluate your ovarian reserves and other fertility
• factors. The ultrasounds will be transvaginal, which are not painful but can be uncomfortable.
• STD/STI testing: You can’t freeze your eggs if you have an active sexually transmitted infection, but after the
• STD is treated, you could proceed.
• Injections for two to three weeks, usually between one and three injections every day, which you’ll give yourself
• into the fatty tissue of your stomach
• During this period, you’ll have between five and seven monitoring appointments, which will include blood work
• and transvaginal ultrasounds (to watch the follicle growth in your ovaries).
• The egg retrieval, which involves being put under sedation. Your doctor will use an ultrasound-guided needle,
• which will go through your vaginal wall up to your ovaries, where the eggs will be taken.

The eggs retrieved will immediately go to the embryology lab and cryopreserved. Then, they will go into storage. The eggs can be frozen indefinitely, though you will need to pay a yearly storage fee. In the future, when you decide to have kids, you’ll first try to get pregnant with sexual intercourse. Hopefully, you won’t even need to use your previously frozen eggs.

The eggs that survive the thawing process will be fertilized with your partner’s sperm (or donor sperm). Assuming you get some healthy embryos, one to three of those embryos will be transferred to your uterus via a catheter.

You will likely take hormones—they may be taken orally, via injection, or vaginal suppositories—before and after the embryo transfer.

Elective egg freezing is rarely covered by health insurance. There are a few high-tech companies offering egg freezing in their benefits packages, but this is unusual.

Is Egg Freezing Safe?

There are some known and unknown risks to egg freezing. The risks are similar to those infertile couples face when they go through IVF treatment and people who become egg donors.

We can’t know all the long-term risks to egg freezing because it just hasn’t been studied. The technology hasn’t been around long enough. There are few (to no) studies on people with good fertility who have chosen to freeze their eggs long term and few studies on children who were conceived via previously frozen eggs.

This is what we do know: Egg freezing does not seem to increase the risk of congenital birth diseases.

In a study of 936 children who were conceived from previously cryopreserved eggs, the rate of genetic birth defects was found to be similar to the general population risk. This study included children conceived both via eggs cryopreserved with the slower, older methods of egg freezing and the newer, vitrification technology.

We don’t know whether child development or later adult health is impacted by cryopreservation of eggs. More time and studies are needed.

In the short term, people who decide to freeze their eggs may experience side effects of the fertility drugs. Depending on which fertility drugs are used, side effects may include hot flashes, headaches, mood swings, bloating, nausea, weight gain, breast tenderness, spotting, and injection site soreness.

What Are the Arguments Against Egg Freezing?

• Very high costs, for a procedure you may not need in the end
• Success rates aren’t high.
• May give a false sense of security. (There are no guarantees your cryopreserved eggs will get you a baby.)
• The realities of parenting later in life must be considered.