10 Questions Every Woman Must Ask Herself Before Freezing Her Eggs
Deborah Anderson-Bialis prided herself on being a proactive woman. At age 26, the San Francisco resident had already earned a law degree, founded a technology company and gotten hitched. Simply waiting until she and her husband were ready to begin a family wasn't their style. Freezing her eggs was.
But after undergoing one $20,000 cycle -- which involves taking hormones to "grow" eggs and then undergoing a surgical procedure to retrieve them -- the couple learned Anderson-Bialis hadn't developed any eggs worth harvesting. She was also told her young body could be in a state of early menopause -- an assertion that turned out to be off-base.
"That obviously freaked us out -- going from kind of, 'Let's tee up our family planning to perfection' to, 'Wow, this is an issue and something we have to deal with immediately,'" Anderson-Bialis, now 30, says. Finding another clinic didn't go as smoothly as planned, either, with the pair receiving weak information about where to go and undergoing three rounds of treatments with little success before getting pregnant on their own last year. "We thought it was going to be super straightforward," Anderson-Bialis says, but the whole process was anything but.
[See: In Vitro Fertilization Grows Up.]
Many women and couples are surprised by the medical, logistical and financial realities of egg freezing, a fertility preservation process that typically involves two to four weeks of hormone injections and birth control pills to halt normal hormone production, up to two weeks of other injections to stimulate the ovaries and "ripen" eggs, one short procedure to retrieve eggs and then a method to freeze and store them indefinitely. Most cycles in women 38 years old and younger yield 10 to 20 eggs, which gives them a good shot at having one or two children in the future, according to USC Fertility. If they want more, are older or have low ovarian reserve -- or their ovaries' capacity to produce eggs suitable for freezing -- they may have to undergo more cycles. "It's not as simple or as one-and-done as most egg freezers are made to believe," says Jake Anderson, Anderson-Bialis's husband.
But as the procedure becomes more socially acceptable, widely available and, in the cases of women whose employers cover some of its costs, affordable, understanding the ins and outs of the process is increasingly important, says Dr. Samantha Pfeifer, associate professor of clinical obstetrics and gynecology and clinical reproductive medicine at Weill Cornell Medical College. "I think we're moving in the right direction," she says, "but I think education and awareness really need to be out there that this technology exists -- and then [that there are] limitations to this technology."
So before committing to freezing your eggs, make sure you can answer these 10 questions:
1. Why am I doing this?
While women's reasons for freezing their eggs vary widely -- from opting to pursue a career before childbearing to reacting to an unanticipated breakup to wanting to preserve fertility before deployment or a medical treatment -- it's important that the reason is their own, says Pfeifer, who chairs the American Society for Reproductive Medicine's practice committee. Freezing your eggs because it's covered by your company, your friends are doing it or you're afraid it's your only choice aren't the best motivations. "People shouldn't feel like they have to," she adds. The truth is, fertility doesn't decline on a daily, or even monthly, basis, says Dr. Joseph O'Brien Doyle, a reproductive endocrinologist and infertility specialist at Shady Grove Fertility's Rockville, Maryland, location. "No one needs that pressure," he says.
2. Is it the right solution for me?
Pinpointing exactly why you want to freeze your eggs may also lead you to a more suitable solution. Anderson-Bialis, for example, ended up undergoing embryo freezing -- or preserving fertilized eggs rather than just eggs -- instead of egg freezing because the process has higher rates of future pregnancies and can appeal to women like her who know whom they want their future child's father to be. Women whose ovarian reserve is low might consider adoption or a donor egg, while those who are ready to begin families now but don't have a partner might look to donor sperm, Doyle says. "[Egg freezing] is not the only option."
3. When should I do this?
Freeze your eggs too early and risk never needing them; freeze your eggs too late and risk needing to undergo more timely, costly and potentially painful injection and retrieval cycles in order to acquire the same number of viable eggs -- that's the tradeoff. "It's a fine balance," Doyle says. While somewhere in the mid-30s seems to be "the sweet spot," he adds, every woman is different. Undergoing a blood test for anti-mullerian hormone, or AMH, to gauge ovarian function can help inform your decision, but the test is imperfect since factors like birth control pills can affect results, Pfeifer says. Low-seeming levels can "inspire panic," she says, "and that's an issue."
[See: 16 Health Screenings All Women Need.]
4. Where should I do this?
Anderson-Bialis and her husband learned the hard way that all fertility clinics are not created equal. Some pump women with hormones and collect many eggs in the name of efficiency; others are more cautious, but risk taking more time and money. Some use outdated methods to freeze eggs for future use; the more modern use vitrification -- a fast-freezing process. Some perform the procedure daily; others, rarely. To make an informed decision, ask clinics how many egg freezing cycles they've performed, how many times they've actually thawed eggs for women who are ready to use them and, if the statistics are available, their success rates of pregnancy from frozen eggs, Doyle recommends. As Anderson puts it: "You don't necessarily want to be a test pilot when it's your genetics and your savings on the line."
5. Is it the best place for me?
A 29-year-old with good ovarian function waiting to meet the right partner has different motivations -- and should be on a different medication regimen prior to egg retrieval -- than a 39-year-old mother with polycystic ovary syndrome who doesn't want her first child to be her last. "This is such a heterogeneous population that what's great for some patients is absolutely horrible for other patients," Anderson says. That's why it's important to talk to likeminded women about their experiences at fertility clinics before committing to one, says the couple, who founded FertilityIQ, a website that collects data and reviews from patients about their experiences at fertility clinics in order to help other women find the best fit for them, in 2015. "If they had a bad experience at a clinic, you should really think about going in a different direction," Anderson-Bialis says.
6. How many should I freeze?
The more eggs you freeze, the higher your chances of a successful future pregnancy, but the more cycles you'll likely have to go through to acquire them. That takes time, money and discomfort, at best. On average, women will undergo 1.5 cycles, according to data from FertilityIQ. Again, the right number of eggs for you is an educated guessing game based on factors such as your age, how many children you think you want and how many cycles you're willing to endure and pay for. Melissa, one of Doyle's patients who asked to be identified by her middle name, used data from Shady Grove Fertility to inform her decision to freeze 43 eggs beginning at age 33 to maximize her chances of being able to have at least two children in the future. Like many woman, she had expected it to be "a one-stop shop [where] you just pulled in, they took what they needed and you went on with your life," she says. In reality, it took five cycles and about 10 months since she performed each cycle back to back, although many women take about a month off in between to let their bodies and schedules rest, Doyle says.
7. How will I pay for it?
Egg-freezing cycles can range from $5,000 to $20,000 -- and that's not counting the medications and storage fees, which can cost upwards of $1,000 annually, the FertlityIQ founders say, although it's closer to half that at Shady Grove Fertility. While companies are increasingly covering at least some of the costs for employees, that's not common. But there are ways to reduce the economic burden, such as through fertility finance loans and medication discount programs, Melissa, a graduate student, found. "I saved thousands of dollars using those programs," she says.
8. Do I have the discipline?
Jamie, a 45-year-old military officer who froze her eggs at age 41, remembers leaving her best friend's 40th birthday party early in order to go home to inject her "trigger shot," or the final dose of hormones before egg retrieval that must be meticulously timed. "During a retrieval cycle, there is no room for vacations, out-of-town trips, spur of the moment meetings and spontaneous parties," says Jamie, whose name has been changed to protect her privacy. The process also involves regular ultrasounds, blood tests and at least one minor surgical procedure that typically requires at least one day off work. "It's manageable," Doyle says, but takes planning and commitment.
9. Am I willing to be uncomfortable?
When your ovaries are swollen with at least tenfold as many eggs as usual, it's not going to feel great. "It's definitely not easy on your body, and it's not easy to fit in with your natural routines or work and travel," Anderson-Bialis says. You'll also have to get comfortable giving yourself shots, and be willing to back off of vigorous physical activity, Doyle says. For Melissa, one of the most noticeable effects of hormone injections was emotional. During one cycle, she recalls, "I just had the shortest fuse."
[See: 8 Ways to Relax Now.]
10. Am I prepared for disappointment?
Even if you take your meds and show up for your appointments, there's always a chance you won't produce your desired number of eggs, if any. And freezing your eggs doesn't guarantee motherhood, since some eggs don't make it through the thawing process, some don't form viable embryos and some embryos don't hold. As Pfeifer puts it: "Twenty eggs in the freezer doesn't translate to 20 babies." Even so, the process was worth it for Melissa, who appreciates how it forced her to take care of her body and finances and become closer with her family. It's also made dating easier because she's no longer worried about finding "the one" before it's too late, fertility-wise. "If I never use one of these eggs, I completely appreciate the process," she says, "because it made me a better person."