“As an ambitious person, the minute I graduated from law school, I worried about one day having to sacrifice my career for future motherhood,” Cecilia, a former patient of mine, told me recently. (With Cecilia’s permission, I’m using her first name to protect her privacy.)
For the first five years of her career, Cecilia focused on her work, traveled internationally, and enjoyed time with her girlfriends. Yet as she approached thirty, her friends began to get married. Still single, she started to worry about finding the right partner. She felt pressured to jump-start the next stage of her life before she was ready.
Last fall, however, Cecilia learned that her company would begin offering reproductive health benefits, including oocyte preservation (egg freezing). Over the past few years, the medical process has been in the news a lot—perhaps most famously after Facebook and Apple started offering the procedure as a (controversial) employee perk. “I felt reassured that by freezing my eggs, I could start a family well into the future, even if it wasn’t for a decade,” says Cecilia. Could this be a way to have her career and safeguard her future family at the same time?
To learn more, she met with a reproductive endocrinologist who told her about the egg freezing process, which typically includes two weeks of daily hormone injections followed by anesthesia and surgery to extract the eggs. While this information didn’t frighten Cecilia, she was shocked when the doctor told her that defrosting those eggs—when it comes time to actually make a baby—is not as simple as it sounds.
“Many women hear about their chances of success as defined by an overall percentage—such as you have a 40% chance that your thawed egg will become an embryo and then a baby,” Dr. Marcelle Cedars, director of the Center for Reproductive Health at the University of California, San Francisco notes. “Contrary to what many young women believe, egg freezing leads to a live birth only 2-12% of the time, and even less for women in their late 30s and early 40s.”
This is because there is a drop-off in success with every step of the baby-making process. After the eggs survive thawing and implantation, the embryo has to survive early cell division, which leads to a final pregnancy rate per egg around 10%.
When you look at these facts, egg freezing is hardly the foolproof plan that many worried women, especially those hoping to use the procedure to prolong their fertility, imagine. In the modern context, a lot of this anxiety can be traced back to a late 1970s Washington Post column warning that “The Clock Is Ticking for the Career Woman.” While it is true that more and more women in the US seem to be waiting to get pregnant, science has not clearly determined how age effects female fertility.
Dr. Anna Glezer, a reproductive psychiatrist at the University of California, San Francisco and founder of Mind Body Pregnancy, counsels women who contemplate delaying motherhood.
“It’s important for women to realize that even if they freeze their eggs, they can’t stop their biological clocks,” she says. “For example, if a woman defrosts her eggs in her late thirties or early forties, she’s already at an advanced maternal age. By this time, even if the pregnancy is successful, she is at a higher risk for pregnancy-related complications like miscarriage, gestational diabetes, preeclampsia, and preterm birth.”
Glezer asks her patients to contemplate “why” they are making this decision. “I encourage women to ask themselves: Is it related to a need for control? If it is, these particular women may feel even more devastated when their reproductive plans don’t go as planned.”
While the option to freeze one’s eggs might alleviate some anxiety about future family planning, many young women are being led to believe that this fertility preservation method is a baby-making insurance plan. “In actuality, many of these women are receiving reassurance,” says Cedars. These kinds of reassurances can have long-term psychological consequences.
While egg freezing is no longer an “experimental” medical procedure, elective egg freezing is relatively new, which means there’s not much data on success stories. Because of this, the American Society for Reproductive Medicine (ASRM) cautions women against choosing this as a tried and true method to delay childbearing.
Cedars encourages her patients to think about the complexities of the egg freezing process, which can be physically and emotionally taxing on one’s body. Some women find the medical process so unnerving that they develop mild anxiety depression and post-traumatic stress disorder. And in a small percentage of these cases, the retrieval results are also disappointing.
Sylvia froze her eggs when she was just 29 years old. A medical resident at the time, she didn’t want the pressure to begin a family before she completed her medical residency and fellowship—a six-year endeavor. She used her savings for the procedure, but unfortunately, her doctor only retrieved three eggs, well below the average amount of eggs produced in one cycle. According to the ASRM, most women Sylvia’s age will produce anywhere between 8-20 eggs per retrieval cycle, and it takes an average of 20 eggs to result in pregnancy.
Because of her young age and pristine physical health, Sylvia’s doctor had reassured her that one cycle would garner a good amount of eggs. But it didn’t. “I felt devastated that I had wasted all of that money, time and emotional energy on a process that produced virtually nothing,” says Sylvia.
While this experience didn’t preserve her future fertility, it did make her a more empathic doctor. Today, Sylvia encourages women who are contemplating egg freezing to gather the medical facts and data, obtain second opinions, and push for open conversations with their physicians. After meeting with her doctor, meanwhile, Cecilia decided to delay freezing her eggs and hired a professional matchmaker instead. But that doesn’t mean freezing one’s eggs should be ruled out as an option. For Cecilia, knowing she has the option to prolong her fertility provides her with hope.
Both Sylvia and Cecilia believe that fertility preservation methods can empower women by helping to lessen the pressure they feel when they’re forced to choose between their careers and future motherhood. “For a long while, women have felt silenced when it comes to talking about their reproductive rights and health concerns,” says Sylvia.
Hopefully, these once-taboo topics are now becoming a regular part of women’s health conversations. Egg freezing may very well be the right choice for some women. But women should not necessarily prolong reproduction just because the technology is available. In the end, it takes more than science to create a baby.