KATHLEEN WORKS 12-hour shifts as a physician assistant in a Baltimore hospital emergency room. She’s 40 and single. And she’s always wanted to have her own children.
After a bad breakup a few years ago, Kathleen talked to her gynecologist about her desire to have a baby—and her fears that it wouldn’t happen. He later told her about a newly improved fertility technology called oocyte vitrification that involves flash-freezing ovarian eggs. The process has been around for about five years, but in October, the American Society for Reproductive Medicine lifted the “experimental” label from the technology because of success rates in live births using frozen eggs. The method is now becoming more mainstream and increasingly available, giving women another fertility option.
“My gynecologist really keeps on top of things, and he told me they had made great strides,” says Kathleen. “He said it really would be worth it now.”
Still, she was hesitant. “You don’t think you’d be in such a place in life,” she says. “But life doesn’t always turn out the way it’s supposed to. I haven’t found that perfect guy.”
Then, in June 2012, soon after Kathleen’s 40th birthday, one of her friends who’d recently undergone in vitro fertilization (IVF) urged her to begin the egg-freezing process sooner rather than later. (Currently, most clinics won’t freeze eggs for women over age 41). So Kathleen made an appointment with Shady Grove Fertility Center’s branch at Greater Baltimore Medical Center.
During the course of about two weeks, she gave herself rounds of hormone injections to spark the production of multiple ovarian eggs, and went in for blood work and ultrasounds. Then a friend gave her the trigger injection to finalize the eggs’ maturation and, roughly 35 hours later, the eggs were removed by a doctor using a fine needle inserted into the ovaries while Kathleen was under general anesthesia.
One of the most challenging steps, says Kathleen, was the hormone withdrawal. “When I went off the hormones the week after [egg extraction], it was brutal,” she says. “I was weepy and crying all the time.”
Kathleen spent nearly $20,000 for the evaluation and two cycles of egg retrieval and medication—and she put most of it on a credit card. She decided to freeze the second round of eggs, for a total of 26, to increase her pregnancy odds. (Doctors recommend banking at least 13 to 15 eggs. A single cycle and related costs might run $10,000, with financing options.) Her health insurance did not cover the procedures. And, when she goes through IVF to have the eggs transferred, that could cost another $12,000 per cycle, though insurance would likely cover some of that cost.
Kathleen has kept her situation private (she asked that only her first name be used in this article), mostly to avoid other people’s judgment. As for the high cost, she says, “I’ll just have to buckle down and pick up some overtime. It’s just about making sacrifices. Even though I don’t have kids yet, I’m already starting to invest in them.”
Just having the eggs banked has given her hope, and maybe time to find a life partner. “There’s a little bit of a sense of relief,” she says. “It’s no longer 100 percent sure that having kids is not going to happen.”
AS OF YET, no one has tracked how many women like Kathleen are freezing their ovarian eggs, though experts estimate there are about 1,500 egg retrieval and freezing cycles annually nationwide.
Currently, doctors recommend banking eggs prior to age 38, with optimal years between 32 and 36—a spread that will likely become the technology’s target population, since younger eggs are more viable. Yet because the vitrification technology is so new, a current wave of women freezing eggs are, like Kathleen, at the cusp of 40 and racing to beat another deadline: the plummeting genetic health of ovarian eggs for women in their 40s. (The likelihood of pregnancy, via IVF, for a woman at age 40 hovers around 20 to 25 percent, with the same clinical outcome for frozen eggs as fresh ones, experts say. Freezing her eggs likely locks in those odds for Kathleen, even if she has a baby when she’s older.)
Shady Grove, where Kathleen froze her eggs, is one of several major fertility centers that offer egg freezing nationwide. One of Kathleen’s doctors at Shady Grove was Dr. Ricardo Yazigi, a reproductive endocrinologist who has followed the technology’s progression and says it’s come a long way. “Human eggs did not used to freeze very well. There was a problem with ice crystals forming in [slow-freezing] methods and the rates of pregnancy were very low,” he says.
The new freezing method, done after water is extracted from the egg, prevents ice formations and yields much higher success rates. “What we are doing is freezing time,” Yazigi says. “Women can freeze their eggs in their early 30s, and then come in, up to their late 40s, and have a child of their own.”
Yet the social experiment of delaying motherhood via egg freezing has sparked a flurry of news stories that question whether women will start putting motherhood on ice: purchasing costly fertility preservation plans, while pursuing high-powered careers or avoiding marriage altogether.
The prospect of younger 20-something women and older post-40 women freezing their eggs has drawn special criticism. Some say fertility doctors might be creating false—and expensive—hope, since there are no guarantees. Others argue that women will become complacent, relying on frozen eggs and difficult IVF procedures instead of trying to conceive naturally before their mid-30s, when it’s more likely.
The ASRM doesn’t yet support freezing eggs solely to delay pregnancy, citing a lack of data on efficacy, cost-effectiveness and health or emotional risks. “This raises a whole set of issues whether women electively deferring their childbearing is reasonable,” noted Dr. Samantha Pfeifer, ASRM practice committee chair, in a recent National Public Radio interview. “When extracting eggs from a young woman at 25, what is the likelihood that she will use those eggs in the future?”
Also, while fertilized embryos can be frozen for many years, it’s not yet clear how long frozen ovarian eggs remain viable. Storage fees can range from $100 to $1,000 annually. “We don’t know the long-term implications,” notes Yazigi of Shady Grove, where storage fees are $360 a year. “We are being reasonably cautious and not becoming too alarmed by information we don’t have.”
Most fertility doctors, at Shady Grove and elsewhere, do not encourage college-age women to freeze their eggs. Yet the baby-making landscape is constantly shifting. Age-related infertility has gone from a social phenomenon to a medical issue: About 1 in 5 women in the United States have their first child after age 35, according to the Centers for Disease Control and Prevention. By some estimates, infertility is now faced by more than 6 million Americans.
Given this, some say gynecologists and physicians need to discuss fertility planning with their patients before they face difficulties. Sarah Elizabeth Richards, the author of “Motherhood, Rescheduled,” a new book about egg freezing, says it should be standard for doctors to provide information, such as a pamphlet, to women by their early 30s.“There’s a fine line between doctors’ ‘mentioning’ and ‘suggesting’ the procedure” to patients, Richards noted in a recent editorial in The New York Times about egg freezing. “But this is an option they [women] should be hearing about from their OB-GYNs.”
WHEN BRIGITTE ADAMS started looking at egg freezing two years ago, a Google search turned up just a few hits on Wikipedia and clinic websites. So, after spending $15,000 to freeze 11 eggs at age 39, she founded Eggsurance.com, a guide to the egg-freezing process that now draws 2,500 unique visits a month—a number that’s growing as more women learn about the technology.
“These women are early adopters,” Adams says of those who have frozen eggs. “Information is mostly spreading by word of mouth. In many ways, the issue of fertility preservation is linked to the struggle many college-educated women now face: The career-family time crunch. Those who enter the sciences, law or even the humanities might find themselves in their 30s and still postdoctoral fellows, or otherwise not yet established in their field.
“There has been a generational shift with education, family building and career building,” notes Adams, who works as a marketing consultant in Los Angeles. “For our parents’ generation, these things were done earlier. But now women are in school much longer. There are more women graduate students than male grad students.
“And, with the current economy, people are staying in jobs longer, or they worry about taking time off for children. So this pushes things out.”
Adams thinks egg freezing could be a real game-changer: accomplishing for women’s fertility “what the birth control pill did for the sexual revolution. I’m seeing a lot of successful women in-the-know who think ‘I’ve got to do something proactive. I might miss this window.’ So they are taking advantage of what’s out there.”
So far, fertility experts estimate there have been only about 8,000 births worldwide utilizing frozen ovarian eggs. Still, some say egg freezing is on a track to become mainstream—especially in combination with IVF.
“Vitrification has had a phenomenal impact on IVF therapy in general, whether egg or embryo,” says Dr. Michael Tucker, scientific director of Georgia Reproductive Specialists in Atlanta, director of IVF at Shady Grove and a consultant to several fertility clinics. “We really might see vitrification become the norm in IVF.”
Egg freezing offers flexibility in certain IVF cycles, says Tucker, including those related to male infertility. They also can be used to help meet the demand for donor eggs. And for some couples with religious or moral concerns, it’s preferable to freeze ovarian eggs, instead of banking large numbers of vital embryos. (A woman’s body naturally discards unfertilized eggs monthly, while some consider fertilized embryos the earliest forms of life.) Donor Egg Bank USA now links clinics such as Shady Grove, California’s Reproductive Partners Medical Group and the Florida Fertility Institute. The bank currently offers frozen donor eggs, much like sperm banks would offer frozen sperm.
There is more research to be done into the long-term effects of egg freezing, including whether children born from such eggs could have developmental delays or other health issues. But those in the field are hopeful.
Says Dr. Yazigi: “Life is getting fairer in the fertility field.”
CAROLYN GOERIG LEE, of Northern Virginia, did not plan to marry in her late 30s, but that’s when she found her husband.
Very soon after the wedding, she got pregnant. “We had a honeymoon pregnancy,” says Lee, a nurse. “But then I miscarried. After that, we decided to freeze my eggs.”
Another pregnancy led to another miscarriage. At 41, she and her husband underwent IVF using the eggs she had frozen at age 39. Of the three eggs that implanted, two developed: one boy, one girl.
The couple painted the babies’ room sky blue and adorned the walls with vintage images of birds and bees.
“It all seems kind of magical,” says Lee. “I was picked up and put in a home with a nursery. It’s like a miracle.”
On March 27, after eight hours of labor, Lee gave birth to Clara Elizabeth Young and Michael David Jin.