cryopreserving hope

On egg freezing

Nude Series XII by Georgia O’Keeffe, 1917

What’s viewed as the penultimate success for the 21st century woman has been shaped by what we’re told are the repressed dreams of our foremothers. As with any narrative, there’s a modicum of truth there but this one is shrouded by what we’re coming to realize is the barbed fabric of a delusional promise. Women in this world take up roles previously reserved for men at costs society has been slow to indemnify.

When you’re a young, healthy (from a reproductive perspective) cis-woman and the topic of having children comes up, there’s this collective reflex that’s like “you’re so young, you have time.” I’ve experienced it, you’ve probably experienced it, if applicable to you. There’s little urgency to accurately reflect the biological urgency of the matter. We’ve mostly figured out how to prevent conception but have little idea how to control it, how to will it when we want to. The reality of fertility and its age related decline is not something we’re made familiar with until it’s often too late. The ability to get pregnant without any intervention whatsoever starts to rapidly decline once cis-women hit 30¹. Now, if you’ve devoted your 20s and 30s to achieving professional prestige (or whatever other reasons)—the prospect of having children an afterthought because your friend or your aunt or your mom “had a baby at 42 with no problems”—this statistical fact strikes like a viper once buried deep in sand.

Companies have started to realize that a sizable percentage of their female workforce has different needs and startups like Carrot have sprung up to help them offer fertility options. The most common option for preserving fertility is egg freezing (oocyte cryopreservation), a process in which you dupe your body into producing multiple eggs, retrieve them, and freeze them at a yearly storage cost. There’s a growing misconception that egg freezing de facto enables optionality to the extent that once you’ve got some eggs in reserve, you can shelf fertility concerns until as late as your 40s. Startups have seized this messaging and used the exorbitant costs of the procedure ($8-10k, not including medication and annual storage costs) to their advantage. A common predatory technique I’ve been seeing is offering women the option to freeze their eggs for free with the catch being that they have to donate some of their eggs. This is often advertised from a social justice angle (for example, Cofertility advertises their service with lines like “Help LGBTQ+ parents and start your egg freezing journey!”) and is marketed as improving accessibility for women who otherwise could not afford to freeze their eggs. While donating your eggs is a noble act, I view Cofertility’s (and similar companies’) model as coercive and deceptive. What fertility clinics and companies don’t often make abundantly clear to us is that even multiple cycles of egg freezing do not always guarantee even 1 live birth. Women are consistently sold a myth and only uncover the truth when it’s too late. This essay isn’t meant to fear-monger I swear, I just feel it’s important to deconstruct deceptive messaging and dispel misbeliefs.

So, let’s investigate the actual live birth rate from freezing eggs. A recent article in the New York Times² highlighted the harsh statistical reality: “new research documents some caveats: how old a woman is when she freezes her eggs and how many eggs she freezes make a significant difference in whether she will have a baby. Most women who tried to become pregnant, the study found, did not succeed, often because they had waited until they were too old to freeze eggs and had not frozen enough of them.” The article links to this study³, which provides the following data:

A total of 543 patients underwent 800 oocyte cryopreservations, 605 thaws, and 436 transfers. The median age at the first cryopreservation was 38.3 years. The median time between the first cryopreservation and thaw was 4.2 years. The median numbers of oocytes and metaphase II oocytes (M2s) thawed per patient were 14 and 12, respectively. Overall survival of all thawed oocytes was 79%. Of all patients, 61% underwent ≥1 transfer. Among euploid (n = 262) and nonbiopsied (n = 158) transfers, the LB rates per transfer were 55% and 31%, respectively. The FLBR per patient was 39%.

**Metaphase II oocytes (M2s): mature oocytes, which are more viable for freezing.

**FLBR and LB: final live birthrate and live birthrate.

39% is not very high if you’ve spent thousands of dollars freezing your eggs, storing them, and thawing and transferring them. What that means is that each egg will have a lower chance of becoming a healthy baby. A 2016 study of 1,171 IVF cycles using frozen eggs found that, for women under 30, each egg retrieved had a 8.67% chance of resulting in a child; for women over 40, that chance dropped to less than 3% per egg. So, to achieve a 50% estimated live birth rate, a woman over 40 will need to freeze significantly more eggs than a woman under 30. This data supports the very insightful and important takeaway from the NYT linked study: “Age at cryopreservation and the number of M2s thawed were predictive of LB; the FLBR per patient was >50% for patients aged <38 years at cryopreservation or who thawed ≥20 M2s.” So the ideal scenario in which to freeze your eggs is when you have a greater reserve of genetically healthy eggs (20s-early 30s) and, once you undergo egg freezing, are able to retrieve at least 20 eggs. This often requires multiple cycles.

Abnormal eggs by age

I've mentioned the costs associated with egg freezing (which are far out of reach for most women, resulting in some seeking options abroad⁴) but have yet to discuss the emotional and physical havoc the egg freezing process wreaks on the body. From doing the initial consult and being faced with the possibility that you’re infertile / will have extreme difficulty conceiving to injecting yourself with hormones multiple times a day risking overstimulation of your ovaries, egg freezing is an incredibly tumultuous experience. And to go through all of that and still not be guaranteed a live birth. We have a long, long way to go. There exists a huge gap in medical literature about how long frozen eggs remain viable and there are few extensive surveys like the ones I discussed above.

Dina Radenkovic, founder of reproductive health startup Gameto believes that “women are living longer; their ovaries could and should be functioning longer, too.” In the immediate future, egg freezing should be far cheaper or, better yet, covered by insurance, and should be less painful to endure. In many research circles, aging is considered to be a disease, and as it follows age-related declining fertility should also be considered as such yet we consider medical intervention (for what would be considered 'social' reasons) in this category to be a luxury. Socially motivated assistive reproductive technology being a human right remains contested⁵ despite societal benefits⁶ and increasing concerns about declining birthrates. When a woman reproduces should not be dictated by biology in modernity.

In the far future, we should eliminate (or significantly delay) the rate at which ovarian reserves of healthy eggs deplete. In the present, we need better messaging about when egg freezing is most effective. To reiterate, women who have the money and support to freeze multiple eggs when they are in their late 20s / early 30s have a far higher chance of successfully having a baby using those eggs several years later. The average age of egg freezing in the US, however, is roughly 38 years old, and in your late 30s and early 40s your chances of freezing enough healthy eggs decreases drastically.

We teach women to be exacting about their appearance, and as a result many young woman spend many hours researching skincare, makeup, botox, fillers, plastic surgery, and other aesthetic interventions. We don’t encourage young women to seize control over their own biology, the limitations of which may severely effect their lives in the future. We set women up to not worry until it's too late, and unfortunately women, not men, tend to be the ones who pay the price for that. A quote I love from Eva Illouz (which I’ve referenced before) in Why Love Hurts:

“It is thus women who now take on the sociological roles of having and wanting children. In that process, the ecology and architecture of the choice within which they operate have changed considerably. In particular, biological time now plays a significant role in shaping women's cultural perceptions of their bodies and their pairing strategies. Women who choose to have children and marriage (or heterosexual domesticity) as the framework within which to raise these children are constrained by a perception of their body as a biological unit organized in and by time.”

It’s certainly unfair that female fertility is affected by time in a way that male fertility is not, but nevertheless women are the ones at a structural disadvantage, and we don’t do a good job of helping them plan around that. Egg freezing offers hope, but for many it turns out to be more of an optical illusion than an oasis.

1. Having a Baby After Age 35: How Aging Affects Fertility and Pregnancy

2. ‘Sobering’ Study Shows Challenges of Egg Freezing

3. Fifteen years of autologous oocyte thaw outcomes from a large university-based fertility center

4. https://freeze.health/blog/international-guide

5. Social egg freezing under public health perspective: Just a medical reality or a women’s right? An ethical case analysis

6. In Favour of Freezing Eggs for Non-medical Reasons by Goold and Savulescu