7 things every woman should know before freezing her eggs
December 18, 2014
Original Source: http://www.pbs.org/newshour/updates/freeze-eggs/
As women age, the likelihood of chromosomal abnormalities climbs, and with it, the risk of miscarriage, birth defects or disorders that makes conceiving more difficult. Egg freezing is seen by some as a way to stop the biological clock, expand reproductive options and preserve the younger, possibly healthier eggs. And for many women looking to extend their childbearing years, it has has become an increasingly attractive option.
The nation turned its attention to the issue in October when Facebook and Apple announced that they would cover up to $20,000 in costs for the procedure.
But just how successful is it? How invasive? How expensive? When it comes to the details, is this something women should seriously consider? And if so, who?
We turned to experts for the answers. Here’s what they told us.
What does egg freezing mean, exactly?
The process of egg-freezing, or in medical speak, oöcyte cryopreservation, involves stimulating the ovaries with hormones to produce multiple eggs, retrieving the eggs from the ovaries and taking them to the lab, where they’re cooled to subzero temperatures to be thawed at a later date.
Why might a woman opt to freeze?
Reasons vary. Some women choose to freeze their eggs for medical reasons. Cancer treatment, for example, can be toxic to the ovaries and cause premature menopause. Dr. Nicole Noyes, director of fertility preservation at New York University School of Medicine, said she’s overseen more than 200 cycles for medical reasons, mostly cancer, with women evenly divided between lymphoma, breast and gynecologic cancers.
But it’s not all medical. About three-quarters of the women who freeze their eggs do so because they don’t have a partner, Noyes said. She is the senior author of a New York University study released in May 2013.
“The primary reason given by women we surveyed is that they are not in a relationship conducive to childbearing,” Noyes said. “The second reason is women have something they need to get done before children, whether that’s their career or school.”
Indeed, among the first wave of egg freezers — those who froze their eggs from 2005 to 2011 — more than 80 percent had no partner, said Sarah Elizabeth Richards, author of the book, “Motherhood Rescheduled: The New Frontier of Egg Freezing.”
But the “why” is shifting, Richards said. Women are increasingly deferring childbearing in order to focus on demanding careers, and the age has dropped.
“The average age at which a woman freezes her eggs is now 36,” she said, down from 38. “Now, and really starting with [the Facebook and Apple announcement], we’re seeing women freeze their eggs younger and younger, and the public narrative around it is changing. Women are doing it for work now, which is very different from the first wave of freezers.”
How invasive is the procedure, and how risky?
The process of retrieving eggs is identical to the first phase of in vitro fertilization, or IVF.
“You are going to get anesthesia and there will be a needle puncturing your vaginal wall,” said Dr. Jaime Knopman, an endocrinologist and infertility specialist with the Reproductive Medicine Associates of New York. “That has a risk for infection, but as far as surgical procedures go, it’s a low-risk one.”
The procedure goes like this: The woman receives a round of hormone injections that stimulate the ovaries to produce multiple eggs. This stage involves frequent visits to the fertility clinic, about five in 10 days, while the ovaries are regularly monitored by vaginal ultrasound. After roughly a week or two of hormone treatments, the eggs are retrieved.
“I think people picture that it’s months of shots and invasive procedures, but in the end it’s a maximum of two weeks,” Knopman said.
The egg retrieval process takes about 10 minutes and is done under mild anesthesia or sedation. Using an ultrasound, the doctor guides a needle through the vagina to the ovarian follicle containing the egg. A suction device at the end of the needle removes the eggs from the follicles.
Retrieving the eggs is technically not that different from getting blood drawn, Noyes said. A needle goes into the ovary and the eggs get gently aspirated out.
“It’s just in a different area of the body: the vagina,” she said. “That makes people eyes bulge when I say it. But it’s exactly the same as a routine IVF retrieval.”
While the surgical procedure is mostly safe, the hormone shots do carry a risk of ovarian hyperstimulation syndrome, or OHSS, which makes some women ill, said Dr. Samantha Pfeifer, chair of the American Society for Reproductive Medicine practice committee. That occurs when a woman responds too aggressively to the hormones and the ovaries become swollen and painful. It can be accompanied by nausea, vomiting and abdominal pain.
When hyperstimulated, the ovaries produce a lot of fluid, which has to be drained from the abdomen with a needle. OHSS tends to happen in younger women in their 20s and 30s, she said, and occurs in less than 5 percent of patients. But in severe cases, OHSS increases the risk of kidney failure and blood clots and in very rare instances, can be fatal.
“It can be managed,” Pfeifer said. “But you can’t always predict who will get it or 100 percent prevent it.”
Will the hormone shots make me crazy?
Not really, but they do cause moodiness and bloating. Noyes compared it to eating too much pie after Thanksgiving.
“You feel more bloated than you do after eating pie. The hormones make the ovaries swell a little bit, because they have to create space to accommodate the multiple expanding follicles, each containing a maturing egg,” Noyes said.
“It’s funny sometimes hearing how people say they feel,” Knopman said. “I’ve had patients tell me they feel amazing and awesome. I’ve had people say they feel great and others say they feel tired. In general the emotions are steady, and I don’t see patients having a crazy, emotional response.”
What are my chances of having a baby later if I freeze my eggs now?
The chance that a single frozen egg will lead to a live birth is about 2 to 12 percent,according to the American Society for Reproductive Medicine. That’s why doctors often recommend having a couple dozen eggs frozen to maximize success.
Success is based on a number of factors, from a woman’s age to the quality of her partner’s sperm, Pfeifer said. According to one study published in the journal Fertility Sterility in May 2013, a 30 year-old woman with two to six thawed eggs had a 9 to 24 percent chance of one of those eggs progressing to a live birth, depending on the method of freezing. At age 40, that number dropped to between 5 to 13 percent.
In a January 2013 report, ASRM said that egg freezing technology has “improved dramatically” and that it should no longer be considered experimental. But the study concluded that there wasn’t enough data to recommend egg freezing for the purposes of delaying childbearing. More data is needed on safety, efficacy, ethics, emotional risks and cost effectiveness.
Is a 35-year-old egg that’s been frozen really healthier than a 40-year-old egg that’s been freshly harvested?
It may be hard to believe that an egg removed from its natural state and frozen for years could more readily lead to a baby than a slightly older egg that’s remained inside your body. But Knopman insists that if you’re a woman in your early 40s, eggs that were frozen in your late 30s are your best chance of conception.
“The most important thing for eggs is time. The younger the egg, the healthier it is,” Knopman said.
Noyes agreed.
“Absolutely. Those younger eggs are healthier,” she said.
But freezing the eggs can cause some damage. Once fertilized, the egg becomes an embryo. Doctors often follow embryo development for about five days in the incubator looking for “blastocyst” formation at the end of this time period. The blastocyst is comprised of two parts; an outer layer, known as the trophectoderm, which is destined to become the placenta and an internal cellular ball called the inner cell mass, which ultimately forms the embryo. Fewer frozen eggs make it the blastocyst stage, Noyes said. But, she added, “the eggs that do seem just as good as fresh eggs.”
But there have been no studies yet on how long eggs can be frozen and survive the thawing process, Pfeifer says. She chaired the American Society for Reproductive Medicine’s committee that declared egg freezing no longer an experimental procedure. At the time, the longest any egg had been frozen was four years, she said. In the majority of studies, the eggs were frozen for a few weeks or months. That’s something that women who don’t plan on having children for a long time need to consider, she said.
“The expectation is they should be fine, but has anyone frozen an egg for 20 years and used it? No,” she said. When to freeze is a matter of opinion; many doctors see 34 as a good age to freeze eggs, though some recommend younger, Pfeifer said.
But Noyes said her clinic recently had success with eggs frozen for seven years — a promising sign, she added.
“Women definitely feel empowered by the experience,” she said. “They come in scared of not having a baby and they leave with their eggs in the bank. They feel like they have a much higher chance of having a baby later.”
Is this an elitist thing? How much does the procedure cost?
At most centers the egg retrieval procedure costs about $10,000, and that doesn’t include the drugs, which alone can range from $3,000 to $5,000.
“Some people will have their medication covered by insurance companies and some will not, because it’s considered an elective procedure,” Knopman said.
Cold storage costs from $500 to $1,000 in annual fees. And when you’re ready to use the eggs, they must be thawed and then fertilized to prepare for the IVF process. Each round of IVF costs somewhere between $3,500 and $5,000.
“So, for now, without insurance coverage, it’s a rich person’s game,” Noyes said.
With no guarantee on how long the eggs will be viable, freezing eggs isn’t always a financially or medically sound choice, especially when women don’t know when — or if — they will want to use them. It’s better to freeze eggs when women are young and healthy, but a woman in her 20s should carefully consider the costs and risks, Pfeifer said.
Egg production starts declining after age 35, Pfeifer said, so a woman in her late 30s or 40s may need to go through the hormone treatments and collection cycles several times. And not all the eggs will be good. Among women over 40, about 15 percent of the eggs produced will be normal, Pfeifer said.
Many doctors recommend freezing about 20 eggs.
“These cycles are not cheap,” Pfeifer said. “You have to think about an individual going through this four times to store up to 20 eggs.”
And Richards pointed out that in certain markets, costs are declining, making the procedure more accessible. Some clinics now offer package deals, where they’ll lower the price if you do three or more rounds of egg retrieval.
“There are some markets offering it for as low as $4,000. When I froze my eggs it cost $13,000, so that’s a big difference,” Richards said. “And at the moment, there is some theoretical talk about parents gifting egg freezing to law school graduates. In reality, when parents know more about egg freezing, it will become more common to have that conversation.”