At one point during Lisa Xu’s second round of egg freezing last year, she thought to herself, How did I even get here? She had been preparing for the egg-retrieval procedure for weeks, first by taking estradiol (a form of estrogen), then taking birth-control pills to sync her hormones, and then giving herself injections every night for about two weeks to stimulate growth for the follicles in her ovaries that each contain one egg. And that was on top of the blood draws and ultrasounds. Xu didn’t respond as well to the follicle-stimulating medication as other people, so she had to take higher doses of it — two or three syringes of medication each day — for a longer period of time than other patients might. Her medication regimen also costs more money than it would for someone who uses less of it, possibly thousands of dollars more. (She estimates she pays $5,000 for her medications per round of egg freezing, in addition to about $15,000 for the procedures through an insurance plan that guarantees a flat rate to retrieve a certain number of eggs, rather than paying per cycle.)
Her providers at the fertility clinic told her she had eight good-size follicles, which meant she could possibly retrieve up to eight eggs, but more likely six or seven, during the procedure during which a doctor would insert a needle into her ovaries to pull the eggs out of her body to then be frozen and kept in storage. Xu already had nine from her first retrieval, and she was hoping to eventually get to 20, a number recommended by researchers for women younger than 38 to have a 70 to 80 percent chance of having one live birth using those eggs. For women ages 38 to 40, the number of eggs recommended for a 65 to 70 percent chance of a live birth increases to 35 to 40, according to this same research from 2015, because the quality of eggs declines as women get older, so it becomes harder to produce a healthy egg that can lead to a pregnancy. (The CDC also has a calculator of IVF success that can give people insight into how many egg-retrieval cycles they may need.)
But her doctor called to tell her they only retrieved three eggs this time. “I tried to put on a brave face and was like, ‘great,’ but inside I was crying,” she said. “Ironically I’m doing this so I can not worry about my fertility, and actually this is making me even more worried.”
Xu is one of thousands of people each year who have elected to freeze their eggs without immediate plans to pursue IVF but rather to preserve their fertility options if needed in the future. Egg freezing has exploded over the past few years since the beginning of the pandemic. In 2021 alone, the number of egg-freezing cycles for fertility preservation in the U.S. increased to 24,560, almost doubling from 13,041 in 2018, according to the Society for Assisted Reproductive Technology. But Xu is also part of the small group of people who have frozen their eggs who regret part or all of going through that process.
Xu, who is 34 now, began the egg-freezing process two years ago after she came upon a free pop-up fertility clinic hosted by Kindbody, a quickly growing fertility chain that has locations across the country. (I went to a fertility clinic to conceive my first child. Kindbody now owns that clinic after a merger in 2022 that left Kindbody valued at $1.2 billion.) The clinic offered a chance for Xu to check her anti-Mullerian hormone level (AMH) — a hormone that can give people some clues into their own fertility, which can be frustratingly opaque. She hadn’t known what AMH was. “Why not?,” she said. She was surprised to find her level was on the low side of what was considered normal for her age.
She didn’t make plans to freeze her eggs then, but after a breakup with her long-term boyfriend, she thought about it again. A friend of hers encouraged her to do it, citing her own experience of freezing 30 eggs after one retrieval. “I think my friends were the lucky ones,” Xu said. About a year after her initial test at Kindbody, she decided she wanted to get tested again and go ahead with the procedure. She was worried about the longevity of working with a start-up like Kindbody, so she found a different clinic she trusted that had a reputable history. When she got her hormone levels checked again, her AMH reading was even lower than it had been the year before.
It’s worth noting that AMH alone can’t tell someone whether they are fertile, and people can get pregnant at almost any level of AMH. But the reading does provide some insight into ovarian reserve, and importantly for fertility treatment, it can give an idea as to how someone could respond to certain medications (generally, a higher AMH means a person is more likely to have more eggs retrieved per cycle). A doctor I spoke with said that because the assays used to test and measure AMH can vary so much, she doesn’t put much stock into the number going up or down as long as it’s in a healthy range. Yet several of the egg-freezing patients I spoke with relied on AMH readings in part to decide whether and when to freeze their eggs.
Xu’s doctor advised her that low AMH doesn’t mean you can’t get pregnant. But along with a low AMH reading, Xu had a low antral follicle count, which can be another indicator of low ovarian reserve. The doctor said that she should consider freezing her eggs right away.
Now, Xu is on her third cycle and facing possibly a fourth retrieval, trying to get to that magic number of 20. “I knew it was going to be expensive, but I didn’t realize I would need multiple cycles,” she said. “I thought hopefully one, maybe two. But I never imagined I would do a third.”
Getting to doctor’s appointments and administering medication during the cycles have significantly disrupted Xu’s life. The timing can be unpredictable depending on her hormones and how her body reacts. “Especially for me because I’m on a longer priming protocol, it’s an additional level of variability,” she said. “It’s very difficult for me to plan anything around this.” The lack of transparency around her treatment and her lack of understanding about the hormones that affect her fertility have compounded her frustration. She didn’t realize that taking birth-control pills can actually suppress antral follicle count, and she watched as her reading climbed over a span of several months. “If I had known actually this changes as time goes by and me being on birth control was a suppressant, I maybe wouldn’t have rushed,” she said.
The toll on her body has been tough, but the toll on her emotions was harder. Undergoing egg freezing without a partner can be isolating — especially in waiting rooms filled with couples doing IVF. “Had I known that there would be additional complications, the need for multiple cycles, all these additional costs, and the emotional and psychological toll, would I have done this for something that is not guaranteed?,” Xu says. She doesn’t have a definite answer, but Xu is now highly wary of recommending egg freezing for people in her position. She still wants kids, but she’s not sure if egg freezing is worth the cost for the small chance these eggs will become embryos. “It’s better that you spend your money on concierge dating services or finding a partner, freezing embryos,” she said.
Another egg-freezing patient I spoke with, who asked to remain anonymous for privacy reasons, echoed those feelings of isolation. She started the process last year, when she was 38, because she thought it would be easy. She ended up with a complication of internal bleeding after her retrieval. She recovered but was close to needing a blood transfusion and surgery to remove a bleeding ovary. “My friends who have not gone through it seem to think it’s easy and don’t relate with all the emotional struggles that come with this journey,” she said in a message. “The process is not as easy as what social-media bloggers make it seem like.” She felt that egg freezing was one of the worst experiences of her life. While she said that she still wants kids and acknowledged that may require IVF, “I would not recommend egg freezing,” she wrote.
And if she doesn’t end up conceiving via IVF or needing those eggs after all, she won’t be alone. A 2023 study from Monash University in Australia showed that most people who freeze their eggs don’t come back to use them. The study, which looked at patients from seven fertility clinics in Victoria, Australia, from 2012-2022 and included those freezing eggs for any reason, including IVF treatment or medical reasons, along with voluntary egg freezing, showed a return rate to use the frozen eggs of less than 13 percent per year. For those who did return to use their eggs, the live birth rate per thaw cycle was 12 percent.
The eggs aren’t necessarily meant to be used, said author of the study Dr. Molly Johnston. They are often frozen just for the chance they are needed in the future. So this low number doesn’t mean that the procedure isn’t working as it should. But if the success of egg freezing isn’t measured by using eggs to make a baby, then how is it measured? Fertility specialist and reproductive endocrinologist Eleni Jaswa, who has studied decision regret from egg freezing, said that one way to measure its success is by how people feel about it.
A 2018 study, which surveyed about 200 women who froze their eggs from 2012 to 2016 led by Jaswa, showed that most people don’t regret freezing their eggs. But those that do face regret, do so most likely because of not knowing enough about the procedure ahead of time, not having enough emotional support doing the process, or getting fewer eggs than expected. Xu faced all those factors. In addition, the more likely someone thought they were to use the eggs, the less they regretted the procedure.
Jaswa’s study also showed that decision regret wasn’t influenced by paying out of pocket versus work or insurance paying for the procedure. But the patients I spoke with had a hard time with surprise expenses. The morning Kate, 37, woke up for her first appointment of the egg-retrieval process, she got a bill from her fertility clinic that was $3,000 higher than what they told her it would be. She burst into tears. She had already spent thousands of dollars on the medication; she had to leave for the clinic soon.
Kate thought that she and her fiancé were perfect candidates to try to freeze embryos, but the egg-retrieval process was more difficult than she thought it would be. Kate wasn’t prepared for how bad she would feel physically leading up to the retrieval. “I just felt like I was rotting in bed for days at a time,” she said. She was at risk of ovarian hyperstimulation syndrome and had to take some extra precautions, like restricting physical activities, though she said her situation is not common. At her retrieval, she got a number of eggs that she was happy with. But then the stress and anxiety of waiting to hear about how many eggs were fertilized, and then how many embryos survived, was gut-wrenching. “I would never — knowing what I know now — just blanket tell someone you should freeze your eggs,” she said.
For years, Kate felt like people had been telling her to do just that without any real insight into her life. “There’s all this focus on how this is guaranteed to give you choice, but there’s very little about the toll it can take or what can go wrong,” she said. She felt a lot of things weren’t readily apparent: the additional costs of genetic testing and other surprise fees, the possible pain of some of the injections, and that even healthy younger women may need multiple cycles to get a certain number of eggs. Not having a clear understanding of one’s own fertility is an indicator of both regretting to freeze eggs at all and regret for not doing it sooner. The egg-freezing process mirrors what the larger health-care system reveals for women: There’s not enough reliable information out there about how women’s bodies work, and there’s not enough emotional or monetary support for good care.
When Hannah Selinger decided to freeze her eggs, she was feeling pressure over turning 35. “I feel like there is this pressure point with women where it’s like, you’re turning 35, you haven’t met anybody, you don’t have any children, you’re aging out of having children, your ovaries are going to dry up — which is definitely not true for most people,” she said. Age is the single most important factor affecting fertility, Jaswa said. But a lot of people don’t have a clear understanding of at what age fertility declines, and a lot of women face pressure about their biological clock.
Freezing her eggs cost Selinger $17,000; she wrote an essay for Glamour four years later about regretting the procedure. Based on her own tests at the clinic and her family history, she had a pretty good idea that she would be fertile. She chose to freeze her eggs at the time because she was single but knew she wanted kids, and she had a financial opportunity to do it using a trust she received after her father died. She met the man who would become her husband a few months after she froze her eggs, and she went on to conceive two children after age 35 without using fertility treatment.
As it turns out, 35 is not actually a cut-off for fertility. More and more people are having babies later in their 30s, with the birth rate for 35- to 39-year-olds increasing to 55.3 per 1,000 women in 2022 from 47.6 in 2007, according to the CDC. Fertility is a long arc, beginning to slow and decline, in general, in a person’s late 20s with a swifter decline around ages 37 to 40 — though for some people that decline happens earlier.
One 35-year-old egg-freezing patient I spoke with decided to freeze her eggs last July because she wanted children but had been single for a long time. “I don’t want to be settling for some loser just because of the whole biological-clock thing,” she said. Her work offered to cover the procedure as a benefit. When it was all over, she had paid around $2,000 of her own money. She couldn’t bring herself to do her first injection, so she called a friend who did it for her. And the next 100-plus over the following three weeks.
The injections didn’t make her feel that bad, she said, and she came away with 18 mature eggs. But her recovery was terrible. Within a few days after her retrieval, she began to experience excruciating cramps. She asked for stronger pain medication, but her providers told her to take Tylenol or ibuprofen. She went into the fertility clinic for a follow-up appointment and couldn’t lay down for an ultrasound because of the pain. “The cramps were radiating through my back, and I was screaming in the office,” she said. She had heard from other people that they were back at work the day after their retrieval. “I was like, Why did everyone tell me that? I had to take a whole week off,” she said.
A few months after her retrieval, she started dating her partner — and she recently found out she was pregnant. She and her partner are thrilled. “Do I regret it? I don’t really know how to answer that,” she said. “Did I need to do it? Probably not.” She feels that there’s some fearmongering for 30-somethings to rush to freeze eggs. “But I think the best thing you can do for yourself is at least that first step [of fertility testing] to find out where your fertility is at in your 30s and see if there’s a reason that you might need to do it or not,” she said.
The problem is many women aren’t having that conversation with their doctors — and vice versa. “I call that ‘fertility benightedness’ — just feeling in the dark,” said Marcia Inhorn, author of Motherhood on Ice: The Mating Gap and Why Women Freeze Their Eggs. “Even in training and OB/GYN training, there needs to be better discussion about fertility and age-related fertility decline. It’s not well taught.” Several patients I spoke with said having those conversations at fertility clinics led to feeling like they were there to make the clinics money, rather than having an open dialogue about fertility goals. “Their goal is to try to get you in the door as soon as possible,” Xu said.
Still, egg freezing continues to be marketed as an empowering choice for women — an ultimate act of self-care to preserve fertility options — which, for many women, it is. But that doesn’t mean it’s as easy as it seems. “When you are a healthy young woman, actually giving yourself three shots a day, going every day to a doctor for two weeks to go through an anesthesia and a procedure, it can bring up a lot for a lot of people emotionally,” Jaswa said. “It’s not just car insurance through Geico.”
By Rae Nudson , 2024-04-02 14:00:31
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