Egg freezing has been in the news lately. Just last month, Secretary of Defense Ashton Carter stated that egg and sperm cryopreservation would be available for active duty troops in the Armed Forces. That makes the Department of Defense and US Government one of the largest employers to cover fertility preservation, along with Google and Facebook.
But many women look at the decision of whether or not to freeze their eggs (elective oocyte preservation) and realize that they would need to pay for it themselves. The issues are complex. Is it worth it? Who is most likely to benefit? How did this come to be part of current family planning discussions?
In January, 2013, the American Society of Reproductive Medicine declared that egg freezing was no longer experimental. A new technique called vitrification is used to rapidly freeze oocytes in liquid nitrogen, thus reducing the risk of ice crystal formation. This technique has led to more eggs surviving the thaw process and has allowed them to be fertilized when the time is right by injecting them with sperm. But how often does this technique result in a baby?
The biggest factor in determining success is the age of the eggs when a woman tries to get pregnant or freeze them. If a woman freezes her eggs when she is 25-30, her eggs are at their peak. Chance of future pregnancy may be as high as 70%.
But one group at the University of North Carolina modeled out the chance of actually needing to use those eggs – assuming you don’t meet a partner in your 30s or 40s – and predicted less than 10% would actually need to use them. There is a 10+ time horizon to find a partner and start a family. Or, if a woman remains single, she may choose to not have a child, or pursue a less expensive alternative such as donor sperm insemination.
The reality is that it’s very costly to freeze eggs. The IVF lab equipment, environment, and skill level of the embryologist are all very expensive and we don’t see the costs dropping like other technologies can. There is never going to be a cost savings when you’re talking about spending upwards of $10,000 per egg retrieval on the front end, storage fees of $500 per year, and another $5000 or so if you thaw and fertilize the eggs 5 years later.
Most fertility centers recommend trying to freeze at least 20 eggs, and it may take 2 or 3 rounds of egg retrievals to achieve that goal. Fewer eggs frozen means less opportunity to potentially create an embryo which could result in a live birth. The European Society of Human Reproduction and Embryology estimates that it will take 20-25 vitrified oocytes for a woman under 36 to result in one live birth (on average). 1
The person most likely to benefit from elective oocyte preservation according to the Mesen model2 is a 37 year old woman. If a woman freezes her eggs at 37, her egg quality is not as prime as it was under age 30, but it hasn’t fallen off too much. Potentially 50% of women could have a baby from eggs frozen at 37 if they decide to use them 7 or more years later, vs 22% chance of pregnancy if they waited some amount of time and started trying to conceive on their own or needed IVF. At age 40, the odds of conceiving naturally or with IVF drop off dramatically.
So, because the 37 year old is facing the more rapid decline in egg quality over the next 5-7 years compared to the 30 year old, she is the most likely to “need” her eggs in the future.
There is no perfect answer, and in fact, our current recommendations are based on models rather than hard data. We don’t really know what the true likelihood is to have a baby from frozen eggs until the women who have frozen eggs come back and start using them. Because elective oocyte cryopreservation became ready for “prime time,” i.e. no longer experimental, in 2013, it will probably be 7-10 years before we have meaningful data.
Many women can’t wait that long, and may choose to go ahead and freeze eggs based on the estimates of success. If the best quality eggs are in women ages 25-30, but the person most likely to need and use frozen eggs in her future is a 37 year old woman,2 elective oocyte cryopreservation may be an option to consider for women between ages of 31-39. Because of the complexity of this issue, regardless of age, we recommend you have a detailed discussion with a reproductive health physician regarding plans for your future family.
A founding partner of SRM, Dr. Thyer is highly regarded for her expertise in Polycystic Ovary Syndrome, or PCOS. She is an expert in guiding patients through both low-tech and high-tech fertility treatments including individualized stimulation protocols, In Vitro Fertilization (IVF), Preimplantation Genetic Screening (PGS), and fertility preservation.
- Oocyte cryopreservation for age-related fertility loss. ESHRE Task Force on Ethics and the Law, Dondorp W et al. Human Reproduction, 2012 May;27(5): 1231-7
- Optimal timing for elective egg freezing; Mesen, TB et al, Fertility and Sterility, Volume 103, Issue 6, 1551-1556. e4
Photo credit: Jake Melara