Last week Facebook and Apple announced that they would now offer egg freezing as part of their health care benefit packages. The days that followed were abuzz with a flurry of commentary and news articles. Supporters touted egg freezing as the most important advancement in women's reproductive freedom since the oral contraceptive pill. Critics claimed that companies offering egg freezing were pressuring female employees to not have children while pursuing a career. In the midst of these articles, bloggers were posting their own opinions, further demonstrating the divide within our country surrounding the reproductive rights of women.
So what is egg freezing?
Egg freezing is a technology in which mature eggs undergo a flash-freeze process called vitrification. Vitrification protects the egg by limiting ice crystal formation, therefore lessening damage to the egg and improving egg survival. This technology has resulted in pregnancy rates comparable to in vitro fertilization (IVF) cycles using fresh eggs. In 2012, the American Society for Reproductive Medicine reviewed new data surrounding egg freezing and lifted its "experimental" label on egg freezing .
Why would a woman freeze her eggs?
There are a multitude of social reasons why a woman would wish to delay childbearing. Egg freezing gives women an opportunity to delay, as they are preserving a group of eggs from an age when the eggs are healthier. In addition, women who need to undergo medical therapies that can damage the ovaries, such as chemotherapy or radiation treatment, can freeze their eggs to preserve fertility. Couples who are undergoing IVF treatment and have ethical concerns surrounding embryo freezing may opt for egg freezing instead.
Since 1970, there has been a 900 percent increase in women over 35 years of age having their first child and a 35 percent increase among women ages 40-44. In a study looking at the reasons why women are delaying having children, 88 percent of women reported lack of a partner and only 24 percent claimed professional reasons. Another 15 percent delayed for financial reasons. Women who do decide to freeze their eggs do so to avoid self-blame and hope to thwart their biological clock.
When should a women consider egg freezing?
Women are at the peak of their fertility in their 20s. Fertility begins to decline as a woman enters her 30s, and by her mid-30s the decline accelerates briskly, reaching nearly zero pregnancy potential by age 45. In our 30s, the miscarriage rate begins to increase as well. The optimal age to freeze eggs is usually in the early to mid-30s.
How many eggs should she freeze?
A woman's age will determine how many eggs are recommended for freezing. Most women will need multiple treatment cycles to collect the recommended number. At Shady Grove Fertility, we recommend a woman less than 38 to bank 15-20 mature eggs. For a women 38 to 40 who may have decreased egg quality, it would be recommended to freeze additional eggs -- 25-30 mature eggs. Much like how it takes the average couple six months to become pregnant, not every egg will result in a pregnancy. Batching allows for multiple attempts at pregnancy.
A critical consideration for anyone interested in freezing their eggs is what a clinic's pregnancy data is using frozen eggs. Many clinics will freeze eggs, but it is a very technique-sensitive process, and therefore essential to know how many freezing and thawing cycles a clinic has performed. "Shady Grove Fertility stands out nationally in that we have had over 200 pregnancies result from the use of frozen eggs," states Joseph Doyle, MD. This is a critical discussion to have with a physician for any woman considering freezing her eggs.
Are there any risks associated with egg freezing?
There is no evidence that egg freezing presents an increased risk to a woman's reproductive or overall health. Although the number of children conceived through the use of vitrified eggs is small, there has been no indication of increased neonatal risk .
Women do need to be well counseled that egg freezing is not a guarantee of pregnancy. In addition, it is not intended to motivate women to delay in family building until an advanced reproductive age. Egg freezing offers protection from the adverse effects of reproductive aging by preserving an egg's potential at the time it is frozen.
The World Health Organization defines reproductive rights as the following:
Reproductive rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health.
It is a woman's reproductive right to decide when she is ready to have children. Egg freezing is an important medical advancement that has the potential to improve the reproductive health of women.
References:
1. The Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive technology. Mature oocyte cryopreservation: a guideline. Fertil Steril! 2013;99:37-43
2. Hodes-Wertz B et al. What do reproductive-age women who undergo oocyte cryopreservation think about the process as a means to preserve fertility? Fertil Steril: 100 (5) 1343-1349e2
3. Witkin et al. What makes a woman freeze: the impetus behind patients' desires to undergo elective oocyte cryopreservation. Fertil Steril: 100(3) S24
4. Cottingham et al. Using human rights for sexual and reproductive health: improving legal and regulatory frameworks. Bulletin of the World Health Organization 2010; 88: 551-555.