Delayed childbearing: Should women freeze their eggs?

By Isabel Platt, Celeste Chen and Anna E. Mazzucco, Ph.D.

April 2014

 

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 offers women the opportunity to freeze their eggs while they are young. These women would then become pregnant at a later age, when they have a father and/or sperm donor in mind. 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?

 

In Vitro Fertilization (IVF)

When a woman wants to have a child using her frozen eggs, her eggs will be thawed, fertilized and implanted into her uterus using in vitro fertilization (IVF).

IVF is a form of “assisted reproductive technology” that has been around since the late 1970s. Most women who do IVF receive injections to ensure that many eggs are available for extraction at one time. While there are some risks to the mother from stimulating increased egg production, most women unable to get pregnant without IVF feel that the benefits far outweigh the possible harms. And babies born using IVF, once called “test tube babies,” are usually just as healthy as other babies (see “Risks” later in this article).

Thirty years ago, IVF involved extracting a woman’s eggs, fertilizing them immediately in the laboratory, and then implanting them in her uterus. Extra fertilized eggs (embryos) were frozen in case the woman decided to use them later on. Therefore, while women have been freezing their embryos for years, the practice of freezing unfertilized eggs is relatively new.

 

What is the success rate of IVF?

In general, the younger a woman is, the more likely that IVF will successfully result in a successful pregnancy. In a study conducted between 2000-2005 involving more than 6,000 women, with an average age of 36, researchers found that about 1 in 4 were able to have a child after one round of IVF using fresh eggs. After three rounds of IVF, the success rate reached 45% to 53%; after six cycles, the success rate was between 50% and 70%.4

How does this compare to women trying to get pregnant the old-fashioned way—without a technological assist? Under natural conditions, about 75% of women at age 30 will successfully get pregnant within one year. At age 35, the success rate drops to 66%; women at age 40 have a 44% chance of getting pregnant over a 12 month period.5

 

How much does IVF and egg-freezing cost?

IVF can be very expensive. If a woman freezes her eggs, she will have to pay for both the egg freezing and the IVF cycle(s) when she wants to become pregnant! The average cost of one IVF cycle (the removal, fertilization, and implantation of a fertilized egg) is about $12,400.6 Depending on the technology, the clinic, and the state, it can cost as much as $15,000 to extract and freeze the eggs, $10,000 for each IVF attempt, and up to $1000 each year to store the eggs.7 These costs are dropping, and fertility clinics typically offer payment plans.

Only 15 states have laws that require insurance companies to cover at least part of the costs associated with infertility diagnoses and treatments, which may include IVF. These states are Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia.8 However, the laws in each state vary greatly in terms of which costs are covered. Egg freezing can become a great financial investment which may not always pay off!

 

What is involved in freezing eggs?

Removing and freezing eggs takes about two weeks and requires several visits to the doctor. The removal process is the same as in standard IVF with fresh eggs. First, the quantity and quality of the eggs are tested to make sure enough eggs will respond well to hormones.9 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.10 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.

These eggs are then taken out of the woman’s body using a needle, with the help of anesthesia to avoid pain.11 On average, 20-30 eggs are removed and then evaluated for their health.12 Healthy eggs are frozen and stored in liquid nitrogen for up to ten years.13

The good part about egg freezing is that it allows a woman to decide when in the next ten years to use her eggs to have a baby. The bad part is that the chances of a woman’s frozen eggs being successfully fertilized, implanted and the pregnancy carried to term are much lower than undergoing IVF using fresh eggs or frozen embryos (eggs that were fertilized with sperm before being frozen).  Unfertilized eggs seem to be more fragile than fertilized eggs, and so they may not survive the freezing process as well.  The success rate of IVF with fresh eggs versus frozen embryos doesn’t seem to be significantly different, suggesting that embryos are hardier and can withstand freezing better.

Of the three egg options available to women who need or want to use assisted reproductive technology—fresh eggs, frozen eggs, or frozen embryos– frozen eggs are the least reliable, although success rates will likely improve with newer freezing technologies.

 

How likely is a women to have a baby using frozen eggs?

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. The fertilized eggs will then be implanted in her uterus.14 In the U.S., several embryos (fertilized eggs) are usually implanted to improve the chance of pregnancy.15 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 associated with carrying more than one child at a time.16

In theory, frozen eggs can be used by women at any age. The American Society for Reproductive Medicine (ASRM) says that if a woman freezes her eggs at age 30, these eggs will still be capable of fertilization even ten years later at age 40. The problem that egg freezing doesn’t solve is this: as a woman gets older, the chances of a fertilized egg being successfully implanted in her uterus drop.17

Fertility clinics around the country have reported birth rates from frozen eggs that range between 35% and 65%, but it’s important to remember that fertility clinics don’t always reveal the number of IVF rounds that were needed or even if a pregnancy resulted in a successful birth. Also, several studies, including one published in 2013, have reported much lower birth rates than fertility clinics (see below).18 19

Pooling data from various studies involving more than 2,000 women, researchers in 2013 were able to estimate the probability of getting pregnant and carrying a baby to term using frozen eggs. In this study, women ranged between 20-42 years of age at the time of egg freezing, with an average age of 34 years.20 For a 30-year-old woman, the chances of a successful pregnancy using frozen eggs after one round of IVF (one round = 2-6 frozen eggs) are between 10 and 24%, depending on how the eggs were frozen. For a 40-year-old woman, the chances are lower: 8-13%, depending on how the eggs were frozen. 21

What is clear from all the information is that given current freezing technologies, using frozen eggs for fertilization and IVF is NOT as effective as doing IVF with fresh eggs or frozen embryos.

 

Risks

Although egg freezing is increasingly common, like all medical procedures it comes with some risks. After the eggs are removed, the woman is likely to experience abdominal discomfort similar to relatively severe menstrual cramps.22The needle used for egg retrieval may cause bleeding or infection of the ovaries.23 An additional risk is that the weeks of fertility drug injections 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.24  A few studies have also suggested links between IVF and a rare, highly curable form of ovarian cancer, called borderline ovarian cancer, and also with endometrial cancer. But some experts think that these effects may be due to other health conditions and lifestyle factors that women undergoing IVF may be more likely to have, and not because of the IVF itself. 25

Egg freezing and IVF have not been shown to put the child at a significant risk for developmental disorders. Most studies have concluded that the risks of autism, mental retardation, and other birth defects are only slightly higher for children conceived through IVF using fresh or frozen eggs as they are for a natural pregnancy.

Couples that have children through IVF sometimes have genetic conditions or medical problems other than infertility that increase the chances of their children being born with a defect of some kind.26 A 2014 study found a 30% increase in birth defects in children conceived through assisted reproductive technologies, including IVF. While this seems high, it’s important to remember that couples having trouble getting pregnant are more likely to have children with birth defects even if they don’t use IVF or other technologies to enable them to have children. In fact, about 20% of couples with infertility problems who conceive naturally give birth to children with some kind of birth defect.27

The most important risk to be aware of is false hope. Until 2012, egg freezing was considered an “experimental” procedure by the American Society for Reproductive Medicine (ASRM). While the ASRM has removed the “experimental” label, it cautions that, “Marketing this technology for the purpose of deferring childbearing may give women false hope and encourage women to delay childbearing.28 It’s worth remembering that no matter how young 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 undergo 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 may still potentially become pregnant through IVF, even though the chances are quite low.29

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 around $15,000, the procedure is much more affordable for celebrities than for the average woman. Like other medical decisions by celebrities, egg freezing should not be taken casually.

 

Bottom line

Egg freezing allows women to have children at a later age than would otherwise be possible and/or to wait until they have a partner to father them.  If a woman’s body responds well to the hormones that stimulate egg production and the eggs are frozen before a woman reaches her late 30s, there is a chance that some eggs will be successfully fertilized and implanted through IVF, which is a relatively safe and time-tested method of assisted reproductive technology.30 For now, undergoing IVF using frozen eggs is far less likely to end in a successful pregnancy than using fresh eggs or frozen embryos (fertilized eggs). In fact, fewer than 1 in 4 women can expect to get pregnant and have a baby after spending more than $10,000 to produce and freeze the eggs, hundreds of dollars a year to store the eggs, several thousand dollars to thaw and fertilize the eggs, and at least $10,000 to undergo one round of IVF.31 Until freezing technologies improve, starting a family with frozen eggs may end up being an expensive pipe dream for many women.

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.

 

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