Many women today are deciding to have children later in life. But women in their late 30s and early 40s are less likely to become pregnant because their fertility decreases as they age. According to the latest research by the Centers for Disease Control and Prevention, about 1 in 10 women have difficulty becoming pregnant, and for women aged 40-44, about half have trouble becoming pregnant.1 2 One option is for women to freeze their eggs while they are young so that they can become pregnant at a later age. Egg freezing, or “oocyte cryopreservation,” is no longer an experimental procedure, but is it safe and effective?3 At what age, and for what purposes, should women decide to freeze their eggs?
Egg freezing and In Vitro Fertilization (IVF)
When a woman wants to have a child using her frozen eggs, her eggs will be fertilized and implanted into her uterus using in vitro fertilization (IVF). In IVF, a woman’s eggs are extracted and fertilized by sperm in a laboratory and then implanted into her uterus. For over 30 years, this procedure has allowed women who were previously unable to get pregnant to have children. IVF is safe for women, and babies born using IVF—once called “test tube babies”—are just as healthy as other babies. On average, about 50% of women who use IVF to conceive will be able to have a child.4
In IVF, a woman’s eggs are immediately fertilized, and extra fertilized eggs (embryos) are frozen in case she decides to use them later. Pregnancy rates from frozen embryos are about the same as from fresh embryos.4 While women have been freezing their embryos for years, the practice of freezing eggs is relatively new. So what’s different about freezing eggs? Frozen eggs are only slightly less likely to be successfully fertilized through IVF compared to fresh eggs. However, because the practice of freezing eggs for later use has only become popular recently, there is less information about the pregnancy success rate for frozen eggs than there is for fresh eggs.
What is involved in freezing eggs?
Removing and freezing eggs takes about two weeks and requires several visits to the doctor. Before the process begins, the quantity and quality of the eggs are tested to make sure enough eggs will respond well to hormones.5 If the tests go well, the woman gives herself follicle stimulating hormone (FSH) injections every day for 7-10 days, and she is seen by her doctor every few days.6 During a normal menstrual cycle, the body chooses a few dozen eggs to be released, but only one egg reaches maturity and ovulates. The added hormones allow as many as 45 eggs (or as few as 0) to ovulate, which makes them capable of being fertilized and producing an embryo. They are taken out of the woman’s body using a needle, with the help of anesthesia to avoid pain.7 On average, 20-30 eggs are removed and then evaluated for their health.5 The eggs that are healthy are frozen and stored in liquid nitrogen for up to ten years.8
Fertility and freezing
When a woman decides to have a child using her frozen eggs, 6 to 8 eggs will be thawed and fertilized through IVF with sperm from a sperm bank or from a husband, partner, or friend, and then they are implanted in her uterus.5 In the U.S., several fertilized eggs are usually implanted to improve the chance of pregnancy.9 In other countries, doctors recommend “elective single-embryo transfer” instead, where only one embryo is selected to be implanted into the uterus. This is increasingly recommended by doctors in the U.S. because it prevents potential complications from carrying more than one child at a time.10 Frozen eggs can be used by women at any age, but the greatest success has been shown to be for women under the age of 42.11
While about half of women, on average, are able to get pregnant using IVF, success rates can vary tremendously. A woman’s chances depend on the age she decides to freeze her eggs, the age she chooses to use them, and her natural hormone levels. Fertility clinics around the country have reported birth rates from frozen eggs that range between 35% and 65%, and the rate is increasing with new freezing technologies.12 13 According to the American Society for Reproductive Medicine (ASRM), if a woman freezes her eggs at age 30, her eggs will be as capable of being fertilized as a 30-year-old’s eggs even if she doesn’t use them until she is 40. However, the chance that a fertilized egg will be successfully implanted in a woman’s uterus declines with her age.14 Although each egg’s individual chance of surviving thawing, fertilization, and implantation is low, the overall likelihood that IVF will succeed is higher because many eggs are used.
Although egg freezing is increasingly common, like all medical procedures it comes with risks. After the eggs are removed, the woman is likely to experience abdominal discomfort similar to relatively severe menstrual cramps.7 The needle used for egg retrieval may cause bleeding or infection of the ovaries.15 An additional risk is that the week of injected fertility drugs could cause mild ovarian hyperstimulation syndrome, which affects up to a third of women undergoing IVF. When this occurs, women may experience abdominal pain, nausea, and vomiting after egg retrieval for one to two weeks. Three to eight percent of women undergoing IVF may experience severe ovarian hyperstimulation syndrome with more intense pain and bloating, which in some cases may be life threatening. Women with polycystic ovaries and women under 30 are more at risk for this syndrome.16
Egg freezing and IVF have not been shown to put the child at a significant risk for developmental disorders. The risks of autism and mental retardation are only slightly higher for children conceived through IVF using fresh or frozen eggs as they are for a natural pregnancy. The slightly higher risk may be explained by the fact that women undergoing IVF sometimes have other medical problems or genetic conditions.17
However, the most important risk to be aware of is false hope. A woman’s fertility drops as she enters her late 30s, so even if she freezes eggs at that age to have a child in her 40s, there is no guarantee that she will have a successful pregnancy. No matter how old a woman is when she freezes her eggs, her chances of becoming pregnant and successfully carrying a baby to term decreases as she gets older.
Why do women freeze their eggs?
Women choose to freeze their eggs for both medical and personal reasons. The American Society for Reproductive Medicine (ASRM) considers egg freezing a “valid technique” for women who want to have children after completing necessary medical treatment that could affect a woman’s eggs or harm her fetus. For instance, women with ovarian cancer or another ovarian disease may need to take medication or go through radiation that could cause infertility. Some women may need to have their ovaries removed, and women who take tamoxifen to treat or prevent breast cancer may also stop ovulating. Radiating or removing the ovaries makes eggs infertile, but if women freeze their eggs prior to treatment, they can still become pregnant through IVF.7
The ASRM does not endorse the use of egg freezing for non-medical reasons because “marketing this technology for the purpose of deferring childbearing may give women false hope and encourage women to delay childbearing. Patients who wish to pursue this technology should be carefully counseled.”3 Apart from the ethical issues, the ASRM may be concerned about too many women opting to have babies in their 40s when the risks of complications are higher.
In 2013, celebrities such as Sofia Vergara and Jennifer Love Hewitt publicly announced that they had frozen their eggs to ensure that they will be able to have children in their 40s. At $9,000 – $13,000, the procedure is much more affordable for celebrities than for the average woman. Like other decisions by celebrities about medical procedures, egg freezing should not be taken casually.
Egg freezing enables some women to have children at a later age than would otherwise be possible. If the eggs are frozen early enough (ideally before age 38) and if the body responds well to hormones, there is a good chance that some will be fertilized and implanted through IVF.18 Although success rates vary, IVF using fresh or frozen eggs is a relatively safe and well-tested method to have children when it is difficult to conceive naturally. While children born through IVF from fresh eggs are no less healthy than children born naturally, it is too early to say if children born through IVF from frozen eggs will be just as healthy in the long-term.
To read more about egg freezing, you can visit www.eggsurance.com, an online community dedicated to providing clear, accessible information about the process. If you are considering freezing your eggs, be sure to talk to your doctor about whether this procedure is right for you.
- FASTSTATS – Infertility. Available at: http://www.cdc.gov/nchs/fastats/fertile.htm. Accessed July 8, 2013. ▲
- NSFG – Key Statistics from the National Survey of Family Growth. Available at: http://www.cdc.gov/nchs/nsfg/abc_list_i.htm#impaired. Accessed July 9, 2013. ▲
- ASRM Press Release: Fertility Experts Issue New Report on Egg Freezing; ASRM Lifts “Experimental” Label from Technique. October 22, 2012. Available at: http://www.asrm.org/Fertility_Experts_Issue_New_Report_on_Egg_Freezing_ASRM_Lifts_Experimental_Label_from_Technique/. Accessed July 8, 2013. ▲
- National Summary | Assisted Reproductive Technology (ART) Report | CDC Reproductive Health. Available at: http://apps.nccd.cdc.gov/art/Apps/NationalSummaryReport.aspx. Accessed July 26, 2013. ▲
- Egg freezing: How you prepare – MayoClinic.com. Available at: http://www.mayoclinic.com/health/egg-freezing/MY02174/DSECTION=how-you-prepare. Accessed July 8, 2013. ▲
- Boston IVF – Egg Freezing. Available at: http://www.bostonivf.com/egg_freezing.html. Accessed July 25, 2013. ▲
- About the Egg Freezing Process. NYU Fertility Center. Available at: http://www.nyufertilitycenter.org/egg_freezing/cryopreservation_process. Accessed July 8, 2013. ▲
- Human Fertilisation and Embryology Authority S and ID. Freezing and storing eggs – HFEA. Available at: http://www.hfea.gov.uk/46.html. Accessed July 11, 2013. ▲
- Magli MC, Lappi M, Ferraretti AP, Capoti A, Ruberti A, Gianaroli L. Impact of oocyte cryopreservation on embryo development. Fertility and Sterility. 2010;93(2):510–516. doi:10.1016/j.fertnstert.2009.01.148. ▲
- CDC – Elective Single Embryo Transfers (eSET) – Assisted Reproductive Technology (ART) – Reproductive Health. Available at: http://www.cdc.gov/art/preparingforart/eset.htm. Accessed July 30, 2013. ▲
- Cil AP, Bang H, Oktay K. Age-specific probability of live birth with oocyte cryopreservation: an individual patient data meta-analysis. Fertility and Sterility. doi:10.1016/j.fertnstert.2013.04.023. ▲
- Egg Freezing > Egg Freezing Services, Female Egg Freezing, Egg Freezing Facts. Available at: http://www.extendfertility.com/egg-freezing.htm. Accessed July 29, 2013. ▲
- Egg Freezing FAQ’s – USC Fertility. Available at: http://www.uscfertility.org/fertility_options/egg_freezing/egg_freezing_faqs.php. Accessed July 29, 2013. ▲
- ASRM Press Release: Probability of Live Birth after Egg Freezing Related to Patient Age and Freezing Method. Available at: http://www.asrm.org/Probability_of_Live_Birth_After_Egg_Freezing/. Accessed July 8, 2013. ▲
- Egg freezing: Risks – MayoClinic.com. Available at: http://www.mayoclinic.com/health/egg-freezing/MY02174/DSECTION=risks. Accessed July 8, 2013. ▲
- The Management of Ovarian Hyperstimulation Syndrome. Royal College of Ostetricians and Gynaecologists. 2006. Available at: http://www.rcog.org.uk/womens-health/clinical-guidance/management-ovarian-hyperstimulation-syndrome-green-top-5. Accessed July 30, 2013. ▲
- Sandin S, Nygren K, Iliadou A, Hultman CM, Reichenberg A. Autism and mental retardation among offspring born after in vitro fertilization. JAMA. 2013;310(1):75–84. doi:10.1001/jama.2013.7222. ▲
- Eggsurance – Everything about Egg Freezing. Available at: http://eggsurance.com/. Accessed July 11, 2013. ▲