Three Ways Egg or Embryo Freezing Are Changing the Fertility World
Putting eggs, embryos, or ovarian tissue on ice has been a hot topic for the last few weeks. Numerous articles have popped up, discussing these options and holding them out as a solution for those who are not quite ready to build their family, or who need to protect their family building options due to fertility-damaging medical treatments. The articles run the gamut from "career women" to a two-year-old in New York about to experience chemotherapy.
British Women Considering Freezing Their Eggs Rather Than Using Them Now
Time reports that a study of 200 women found that, "half of those pursuing degrees in sports or education would consider freezing their eggs to give them the option to delay starting a family, while more than 8 out of 10 women pursuing a medical degree said that they would do so." A second study in Belgium found that half of the 15 women interviewed would freeze their eggs in order to take the pressure off of finding a partner in time to utilize the woman's fertility.
I'm not really shocked at the results. Certainly, as IVF has become commonplace, attitudes surrounding IVF have relaxed and many see the idea of egg freezing as a great leap forward in allowing women the same gamete safeguards given to men, especially when it comes to preserving fertility prior to undergoing medical treatments that would impair fertility. Men have been able to freeze and thaw their sperm for years, but it has only been in recent years that scientists have been successful in freezing eggs.
Which opens many more doors than simply freezing embryos.
Prior to recent years, scientists had great success with freezing embryos -- in other words, eggs that had already been fertilized. But this didn't provide a wide-range of options for women who weren't in a partnership. Those wanting to preserve their fertility -- either due to career, relationship status, or medical treatments -- needed to either pair their eggs with donor sperm or use the sperm of someone they may be in a relationship with at the moment. Egg freezing releases women from only being able to utilize their gametes with a donor, and provides the same options afforded to men.
The study was additionally discussed by Fox News, which points out that at this point, there is more discussion than action:
Gorthi said none of the medical students in the study had frozen eggs, that the youngest woman to freeze eggs in her clinic was 28, and that it was most commonly requested by women in their late 30s, whose fertility had already started to decline.
Reuters reports that over half the fertility clinics in the United States are offering egg-freezing options, though many do so with restrictions:
The researchers found that a third restrict the option to cancer patients or as an alternative to freezing leftover embryos for women attempting in vitro fertilization. And while two-thirds of those clinics that offer it will do so electively, no more than a third will provide it to women over 40 years old.
A fairly detailed article in the Daily Mail also explores the study, pointing out many of the fallacies the general public holds about the reach of IVF.
Creating Embryos for Later Use
The Washington Post had a perky article about a couple who has created and frozen embryos because, after eight years of marriage (and in their early thirties), they still aren't ready financially to become parents. They state that their reason for delaying parenthood was that, "It was very important to us, though, that we first be financially stable enough to support them and give them plenty of parenting time."
Which is all well and good, but it begs the question how much money this couple believes they need to have in order to be ready to parent. They happily spend the exorbitant IVF fees, including the blood work, ultrasounds, and surgery bills. (She found fertility drugs too scary, so she opted to use a non-medicated IVF protocol.) They pay for ongoing cryopreservation. And they endure the physical strain of IVF, which almost always informs the financial strain of IVF, including missed work time. All for the ability to delay family building until they are financially stable. The costs:
A three-cycle package of minimal-stimulation IVF or natural IVF costs about $11,000. Pre-screening evaluations and blood tests cost about $2,000. The annual storage fee for the frozen embryos is $300 to $500 per year, and it costs about $1,000 to $2,000 each time embryos are transferred into the uterus.
Do you see the discrepancy in this situation?
The couple did a lot of research on IVF (I'm sorry, they did research on what they like to call "Desperation IVF," since they are at riding across the new frontier of what they like to differentiate as "Preservation IVF"). They obviously also did a great deal of research into general fertility statistics. It seemed like they made this decision with great consideration.
But never once in the article did they talk about what they would do with these embryos if it turned out that their delay in starting parenthood was actually due to ambivalence. I got a strong sense as I read the author's words -- especially the fact that they could so quickly conclude at 30 that children might not be in their future -- that perhaps they would be happier not being parents. That parenthood is more something they think they should do, an option one should leave open, rather than something they are very keen to do. And I hope those who know for a fact that they would like to live child-free do not have additional pressure placed on them because this shiny, new option exists.
Even if they had this a conversation between themselves about the future of their frozen embryos should they decide not to use them, it was a major oversight in not including that piece of the puzzle in the article. All couples -- "desperate" or preserving -- should have a plan in place for the destruction, donation, or usage of those embryos.
The author collected and posted the resources she used to make this decision, and while I think it's a wonderful option for those who know beyond a doubt that they would like to become parents down the line or are already entering into "advance maternal age" territory, I find it somewhat wasteful for a 30-year-old to create this type of insurance plan in this economy with no known fertility risks. If you can afford to do it, you can afford to have children. (If insurance didn't pay for their five or more cycles, the couple spent around $24,000 creating the embryos and those fees are before cryopresevation or using the embryos.) Statistical chances also fall in favor of being able to conceive a child at 35 rather than being diagnosed as infertile. While I rarely tell people to wait to conceive, in this case, she is more likely to never need these embryos than to wish that she had them if she was diagnosed as infertile due to waiting to build her family.
I wish her focus had been on something other than the financial side of the situation, especially when she includes how much money she's really saving by creating this "insurance" plan, which is based on a fairly slippery number of $71,000.
In any case, these amounts didn't seem so large when we read a report in the journal Fertility and Sterility, in which Richard H. Reindollar of Dartmouth estimated the average cost of IVF to be $71,000 for infertile couples.
To counter that figure, ASRM (American Society for Reproductive Medicine) prices the average IVF cycle at $12,400.
If she had stated her reason for waiting for parenthood to be an unsureness of whether she wanted to parent, I would not be dissecting her decision like this. But if she is going to bring finances into play, they need to be examined in the context of this current economy. Especially an article like this that encourages (and in some case, creates pressure) people to spend money they don't need to spend in order to chase a mythical status of financial stability.
Preserving Fertility in the Face of a Medical Condition
Lastly, a two-year-old in New York became the youngest person to preserve her fertility by having her ovary removed prior to undergoing chemotherapy. Her parents simply wanted to present her with all possible options in her future, not knowing how their daughter would feel about her fertility. Babble points out:
Of course, there are other ways of having children these days (adoption, surrogacy, donor eggs), but it’s hard to fault her Violet’s mother for wanting her daughter to retain the possibility of conceiving a biological child.
Half of the commenters on the post agreed that they would allow their child to undergo this procedure in order to have a chance at preserving fertility.
The Herald's report on the story also points out the reality that is at the core of all three of these stories: that these techniques are still experimental, not guarantees. A woman can bank her gametes only to discover down the road that they don't survive the thaw, or they can't be fertilized, or her body simply doesn't accept the embryo and it fails to implant. With the return of the toddler's ovarian tissue, her body may or may not be able to generate eggs or carry a child to term. That all these procedures carry with them a lot of hope, but few promises. And despite all of that, in the face of decent success rates, we take that leap because it's the only leap we have to take sometimes.
Knowing the price tag, would you be willing to freeze your eggs, embryos, or ovarian tissue for a chance at preserving your fertility down the road? What reasons would be acceptable for you?