In fact, women were choosing to delay childbearing far before the emergence of these benefits, or the technology that heralded them. The average maternal age at the time of first birth has steadily increased in the United States in the post-Feminine Mystique era, and has approached 30 in some ethnicities.
Understanding this trend allows us to determine why the option to freeze eggs is potentially important. Women choose to delay childbearing simply because they’re not ready— be it because they don’t want to feel pressured to find a partner, because they have a stronger desire to focus on their career, or because they want to be more established financially. Unfortunately, these desires often don’t jive with their ever-ticking biological clock. Unlike men, women are born with their full complement of eggs, and that pool declines through life. While a woman’s most optimal reproductive potential occurs in her 20’s-30’s, she will experience a decline in her fertility as early as her early 30’s and a more significant decline before entering her 40’s. So, if a woman chooses to delay childbearing until these later years, what she may face instead is a more difficult journey to build her family. As such, the option to preserve her reproductive potential at a younger age, by freezing her eggs, would provide her with a back up plan.
For some women, freezing eggs is a necessity- they may have a predisposition to early menopause or they may be facing medical treatment that could render them infertile. The most common culprits affecting women in this group include chemotherapeutic agents used to treat cancer or autoimmune illnesses. Regardless, it is critical that these women are given the opportunity to learn about the potential harm to their reproductive potential as well as to discuss options for fertility preservation. For others, egg freezing is considered for social reasons, and is an incredibly personal decision. For these women, it’s important to gather information, to understand the benefits and risks, and to take the step that’s in alignment with their individual journey towards building a family. I would encourage any woman interested in preserving her reproductive potential through egg freezing to meet with a fertility specialist to explore her options; but to help start the conversation, below are some of the more common questions I’ve discussed with friends, family, and patients who have been interested in this technology.
The risks of egg freezing are generally low. There are risks during both ovarian stimulation (during which you take injections for 9-12 days) and egg retrieval. The main risk during ovarian stimulation is an over-response syndrome; however, as there are several strategies that can be utilized to minimize this risk, the incidence remains low. The risks for egg retrieval are similar to those encountered with minor same day surgery.
To date, there have been thousands of babies born from frozen eggs. Promising data support that there is no increased risk for birth defects, chromosomal abnormalities, or pregnancy related complications in pregnancies created from frozen eggs. However, it will take many more years with longer follow up data to determine the definitive answer to this question.
If I do a cycle or more of egg freezing, would I run out of eggs at an earlier age?
A woman is born with approximately one million eggs, but she will only mature and ovulate several hundred of them before menopause. Thousands of eggs are lost each month during this maturation process. During a cycle of egg freezing, eggs that are recruited are those that would be otherwise lost; therefore, undergoing one or more cycles will not accelerate the time at which you would enter menopause. In simpler terms, ‘use them or lose them’ is quite applicable to a woman’s eggs in any individual cycle.
Although earlier slow freezing technology yielded a lower chance for egg survival through the warming process, along with a lower chance for live birth, the development of vitrification (or “flash freezing”) has led to comparable live birth rates when compared to pregnancies created from fresh eggs. Still, egg freezing should never be considered a guarantee for future pregnancy.
Live births have been reported from eggs frozen for between 2-10 years. Theoretically, however, egg quality should not decline with longer term storage.
This number is dependent on your age and how many children you plan to have. Based on thaw survival, developmental competency, and fertilization rates, one should aim to freeze roughly 10-15 eggs for each desired pregnancy.
This is a tricky question, and somewhat of a double – edged sword. A recent study by Steiner, et al, highlights the importance of this decision making process. The highest probability of live birth is seen when elective egg freezing is done <34, as the strongest predictor for live birth following in vitro fertilization is the age of the egg. However, if you freeze your eggs in your twenties, or even early thirties, there is a good chance that you will still have the opportunity to get pregnant naturally. In this scenario, freezing your eggs served as insurance, and you may never need to utilize them. On the contrary, the largest benefit (compared to no action) may be seen at later ages, as women who choose to delay childbearing will have a better chance for pregnancy utilizing relatively younger eggs. The downside to this scenario, however, is that if women delay childbearing to later ages (early 40’s) and don’t conceive with their frozen eggs, they have potentially missed their window for natural conception as well. Ultimately, however, if you are considering egg freezing as an option, it is always best to pursue a cycle sooner rather than later.
The longest journey begins with a single step. For women concerned about their future fertility for reasons that are medical, social or financial, the best first step is an open discussion with a Reproductive Endocrinologist and Infertility specialist (REI). This may be the best method to determine whether your plans, or your eggs, are better served ‘on ice’.