Egg freezing does not really beat biology. It buys a small chance at giving birth, but at a very high price indeed.
A common refrain I hear from women who are thinking about freezing their eggs is, “This is not plan A. It’s my backup plan.” This plan B (or even plan C) may in fact be a woman’s parents’ plan. They are willing to pay for their daughter to undergo egg harvesting so she can freeze her eggs to ensure that grandchildren will one day arrive, hopefully while they are still living and able to enjoy them.
News articles on egg freezing tell the stories of women who decide to freeze their eggs out of “desperation.” They talk about their fear of “loss” and “grief.” These are not words used by women who are acting from a sense of being liberated.
Brigitte Adams, a Los Angeles-based marketing director, froze her eggs at thirty-nine. She refers to the age when a woman decides to freeze her eggs as her “desperation level.” New York career woman Nette talks about the drive she suddenly felt to find “Mr. Right, Mr. Wrong, whoever was out there” in order to have children. Leah describes how she had hoped to be married by now, but her boyfriend was in a different place. She “knew she was coming dangerously close to the age when eligible men might search her eyes for desperation, that unseemly my-clock-is-ticking vibe.” She calls freezing her eggs “my little secret . . . I want to feel there’s a backup plan.” Older women, past their childbearing years, tell younger women who are hoping to preserve their fertility by freezing their eggs, “You’re so lucky, I wish I had known to freeze my eggs.”
Those in the egg-freezing business are banking on this kind of desperation. These egg bankers seize the opportunity to profit from women’s fear and worry. One site, Extend Fertility, markets its services with this:
The “biological clock” generally stops ticking in our late 30’s or early 40’s. Our opportunities are endless, but our egg supply and egg quality are not, that is why more women are seeking egg freezing services.
Another site, calling women to “take control,” tells them, “Freezing your eggs offers a way to keep your options open.”
The practice of egg freezing has been used for some time in the area of animal preservation. In animals, the freezing of eggs, sperm, and embryos has been used to help move species off of the endangered list. “Frozen zoos” store the genetic material of hundreds of species in order to protect them from extinction.
In 2008, I attended a conference in London where renowned reproductive endocrinologist Theresa K. Woodruff described the importance of freezing eggs to help endangered species proliferate. I initially thought, “How cool is that?” Then her lecture moved to her work in the area of “oncofertility,” a term she coined to describe her work of bringing oncologists and fertility specialists together in order to help women preserve their fertility by freezing their eggs before undergoing treatment for cancer. Perhaps an ethical case could be made for this use.
But now the market has expanded and a new business has developed to promote and encourage egg freezing as a lifestyle choice or as insurance against the ticking biological clock—a situation thrust upon women by myriad reasons not necessarily of their own choosing.
And in all the slick marketing, what are these egg-banking services not telling women?
Egg Banking is Costly
One cycle of egg freezing can easily cost upwards of $18,000. This includes the initial consultation, lab work and testing, the fertility drugs needed to hyperstimulate a woman’s ovaries, and the procedure for harvesting the eggs and putting them into cold storage. Moreover, it is not uncommon for a woman to go through this procedure more than once. Because egg freezing still has a high rate of failure, clinics often recommend that a woman bank between fifteen and twenty eggs. One fertility center offers this advice:
While there can never be “too many” eggs frozen in the pursuit of fertility preservation, an important lesson learned from our success with frozen eggs is that it is best to be prepared to encounter a percentage of eggs obtained that are either not suitable for freezing or unable to survive the treatment of the eggs.
Then there are the monthly storage fees, which include a standard $500 set-up charge and $250 a year for upkeep and maintenance. If a woman banks her eggs in her thirties for use in her forties, one can easily see how quickly these costs add up. One site crunches the numbers and says, “The whole process could cost upwards of $50,000.”
Once the woman is ready to have a baby, she must then incur the costs of in vitro fertilization and embryo transfer. Depending on how many attempts are needed to achieve a pregnancy and birth, this can add tens of thousands of dollars to the costs. Perhaps this is why most of the egg-freezing websites show pictures of diverse professional-looking women—women of low income need not even apply.
Egg Banking is Risky
The egg harvesting required for egg freezing carries both short-term and long-term risks. The most severe risk is Ovarian Hyperstimulation Syndrome (OHSS). This risk is more common among younger and thinner women. Because women have to undergo a minor surgical procedure to retrieve the eggs, there are also the potential complications that accompany any surgical procedure. And there are longer-term risks of cancers associated with the fertility drugs the women have to take, especially if they are aggressively stimulated in order to harvest fifteen to twenty eggs in one cycle (a real temptation, given the high costs of performing each egg-harvesting cycle).
Egg Banking Does Not Guarantee a Baby
Perhaps the most egregious omission from the ads promoting egg freezing is that there is no guarantee that freezing and banking your eggs for later use will produce a pregnancy that results in a live birth. In the early days of human egg freezing, it could take a hundred eggs to produce one baby. Slowly, over time, new and improved methods have been developed to increase success. Meanwhile, many make money by using women and their future children as guinea pigs.
Human eggs are difficult to freeze because, unlike human embryos, they have a high water content and thus tend to crystallize with ice formation during the freezing process. Many women who froze their eggs before the late 1990s would have had their eggs frozen by the “slow-freeze” (SF) method. In the late 1990s, a new vitrification freeze (VF) method was developed to try to improve the success rates of egg freezing and thawing.
The American Society of Reproductive Medicine (ASRM) states, “IVF with frozen eggs results in lower live birth rates than fresh IVF cycles.” Factoring in maternal age—since much of this is about beating the biological clock—the hopes and dreams of a baby later may be even more tenuous. Simply put, many women are banking on dreams of a child that may never come.
The ASRM report states that the age of a woman when her eggs are frozen plays a significant role in later embryo implantation rates. Women who froze their eggs using the slow freeze method before age thirty have an 8.9 percent “likelihood of implantation per embryo,” which declines to 4.3 percent if eggs are frozen after age forty. For women who used the newer vitrification method, the implantation success is 13.2 percent for embryos created from eggs that were frozen at age thirty. That drops to 8.6 percent with eggs frozen at age forty. And these are just the implantation rates, not the live birth rates.
Feminism and Motherhood: What Happens to a Dream Deferred?
Egg banking does not erase the biological reality of maternal age. The ASRM report states that live birth rates declined consistently with maternal age, regardless of whether the eggs had been frozen using the SF or the VF method. Even if, under optimal conditions, we can freeze the eggs of a thirty-year-old woman and give her a 13 percent chance of an implantation in her forties, there is still a very high risk of maternal morbidity and stillbirth.
A pregnancy for a woman in her forties has a rate of infant mortality second only to that of teen pregnancies. One study showed that “more than one fifth of all pregnancies in 35-year-old women resulted in fetal loss; for women at 42 years of age, more than half of the intended pregnancies (54.5%) resulted in fetal loss.” In short, “there is an increasing risk of fetal loss with increasing maternal age in women aged more than 30 years. Fetal loss is high in women in their late 30s or older, irrespective of reproductive history.”
In 2001, the ASRM launched an educational campaign, “Protect Your Fertility,” to better inform women of these dangers. The biological clock is real. For both mother and child, pregnancy is better earlier rather than later. Assisted reproductive technology is not a magic pill to take when you are ready for a baby. Sadly, some feminist groups criticized the initiative, called it a “scare campaign” urging women to “hurry up and have kids.”
This is the same feminism that misled Anne Taylor Fleming, author of Motherhood Deferred, to describe her own feeling of empowerment like this:
Armed with my contraceptives and my fledgling feminism. . . with our birth control pills and the exhortations of the feminist foremothers to urge us on, what could stop us? We were the golden girls of the brave new world, ready, willing, and able to lay our contraceptively endowed bodies across the chasm between the feminine mystique and the world the feminists envisioned.
However, this empowerment eventually left Fleming on the baby chase. While Mr. Right may not come along (or may not come along during our fertile years), egg banking is no guarantee that motherhood deferred is just a frozen egg away.
Simply put, egg freezing does not really beat biology. Rather, it buys a few women who have adequate means a small chance at giving birth. But this small chance comes at a very high price indeed—$18,000+, short- and long-term health risks, and absolutely no guarantees.
This article originally appeared at The Public Discourse
- Jennifer Lahl, MA, BSN, RN, is founder and president of The Center for Bioethics and Culture Network. Lahl couples her 25 years of experience as a pediatric critical care nurse, a hospital administrator, and a senior-level nursing manager with a deep passion to speak for those who have no voice. Lahl’s writings have appeared in various publications including Cambridge University Press, the San Francisco Chronicle, the Dallas Morning News, and the American Journal of Bioethics. As a field expert, she is routinely interviewed on radio and television including ABC, CBS, PBS, and NPR. She is also called upon to speak alongside lawmakers and members of the scientific community, even being invited to speak to members of the European Parliament in Brussels to address issues of egg trafficking; she has three times addressed the United Nations during the Commission on the Status of Women on egg and womb trafficking.