Many single women in the U.S. today are torn as to whether they should consider egg freezing. In 2016, we estimate more than 10,000 women will opt to freeze their eggs, but the truth is that it’s a hard decision and, for many, the consideration process is marred by half-truths and misinformation.
This is a deeply personal decision with a lot of variables to consider. The questions involve a woman’s age, her fertility history, her family goals, her perspectives on finding a partner, her budget, and more. Here, he will focus mostly on age, and in other FertilityIQ articles, you can find a more detailed analysis on cost, likelihood of use, the medical risks and more.
The Investment of Egg Freezing
To oversimplify, we think of egg freezing as an investment: you are making a short-term sacrifice in exchange for a hoped for, but uncertain, return. Here is how we think about the component parts:
Short-Term Investment: You will subject yourself to a process that costs $10,000 - $20,000 per cycle up-front, along with annual storage costs of $500 per year on average. Each cycle involves weeks of hormone therapy (delivered via daily self-administered shots) and culminates in a moderately painful procedure to extract your eggs. Approximately 5% of women will suffer painful complications, like ovarian hyperstimulation syndrome. Our data shows the average woman who freezes her eggs feels uncertain of whether she was successful and therefore undergoes a second cycle, which comes as a surprise to most.
Likelihood of Use: Today, 10 – 20% of egg freezers come back to use their frozen eggs. Thus, the majority of patients never discover if their investment “paid off.”
Hoped-For Result: If you cannot conceive later in life, and need to resort to IVF, the hope is that these eggs are available, work in your first IVF cycle, and earn you a healthy pregnancy. The intuition is that if your frozen eggs are needed, and perform, they will save you the time, money, and the heartache of multiple failed IVF cycles. For context, the average successful IVF patient undergoes three cycles and spends more than $60,000. That does not include the patients who run out of hope, or money, before they reach their goal.
Criteria to Decide
If There’s Reason to Believe You’ll Need IVF in the Future
If you believe that one day you will need to do IVF, you should consider (and we mean just that, consider) egg freezing. For some women with tubal blockage or scarring, or a partner with male factor infertility, the process of family building likely will be routed through an IVF clinic. As with any patient undergoing IVF, your likelihood for success decreases with age, assuming you are using fresh eggs. If you suffer from endometriosis, it’s not a lock you will need IVF, but you’re more likely than the average woman to need it (30% of IVF patients have endometriosis), and the same goes for women with PCOS.
This is a tough one. While it’s not the norm to use IVF, when a woman does need to undergo IVF in her late 30’s or early 40’s her success is very limited, and there’s no good way to turn back the clock. There are a few numbers we think are interesting on the subject. In the chart below, you can see that of the total live births each year for women over 40, about 90% of them occur naturally.
But, and it’s a big but, there are many women who attempted to get pregnant through IVF, with their own eggs, in that age range, who failed. By our estimates, upwards of 20,000 - 30,000 patients over 40 attempt IVF in a given year with their own eggs (and many more try naturally and with less invasive fertility treatments), and those patients only get between 600 - 3,000 live births.
So if you consider the total number of women likely trying to get pregnant over 40, the likelihood of needing IVF is probably more than what’s reflected by the 9% of live births attributed to IVF. Also, when you see the IVF births in the chart above, many of those were the result of IVF with donor eggs, not with the patients’ own eggs.
Age as a Filter
Age is a crucial factor in considering whether to freeze your eggs. Age impacts both the likelihood your frozen eggs will work, and the likelihood you will ever need to call upon them in the first place. Women who bank their eggs at younger ages are more likely to have those eggs work, but they are also far less likely to ever need them.
How Age Impacts Whether Your Eggs Will Work
For a woman to have a healthy birth, she needs to conceive using a high-quality egg. With egg freezing, getting many high quality eggs is key, and younger women have a distinct advantage here: they produce more eggs, and a higher proportion of their eggs turn out to be good.
Let’s look at a study from RMA of New Jersey. Here you can see the number of eggs per retrieval broken down by age, and as you can tell, women under 35 are able to retrieve more eggs than women over 35.
RMA of New Jersey then looked to see whether these eggs produced chromosomally normal, or abnormal, embryos. As you can see, eggs produced by younger women are more likely to be of higher quality, and in turn, produce higher quality, chromosomally-normal, embryos.
As a result, women who freeze their eggs at younger ages are more likely than older women to get a live birth from those eggs. Below is a study from Europe that looked at 140 women who froze their eggs and then came back to use them. As you can tell, younger patients (at time of freezing) recorded dramatically higher rates of success.
Recently, investigators at a major academic medical center in the US build a predictive model based on their experience with over 500 patients. As you can see in the table below, outcomes depended heavily on egg quantity and age. Patients under 35 who froze 10 eggs had babies 71% of the time, whereas patients with the same number of eggs at 39 years old had a 39% chance, and patients who were 42 had only an 18% chance. Also of note, for patients under 35 who froze 20 eggs, 92% of them had live births, versus 63% who had live births with the same number of eggs at 39.
How Age Impacts Your Likelihood of Using Your Eggs
If you look more closely at the European study, you’ll notice only a small percentage of patients (less than 10%) actually returned to use their eggs, and we are seeing similar numbers here in the US. Age figures in here as well. As of now, it’s the women who banked their eggs later in life who typically return to use their eggs, not the younger women. However, given that egg freezing for personal use is relatively new, research has had less time to study whether younger women will return to use them one day in the future.
For a woman who is in her mid-20s, generally speaking, there is a high likelihood in the next decade and a half that she’ll find a partner and, if she wishes to conceive, do so naturally. A cynic might say the younger woman, who spent $15,000 on egg freezing plus storage fees, and who never came back to use her eggs, wasted her money.
So a major question arises: if older women, say in their late 30s, are likely to need their eggs, but not as likely to have them work, what should they do? There are a range of perspectives on this, but here are two truths:
First, regardless of your age, the younger the eggs that you use during IVF, the more likely they are to work. A woman’s eggs at age 38 are going to be of higher quality than her eggs at age 43. The quality of those 38 year-old eggs may not be “superb,” but they may be “superb by comparison,” and any woman looking at the prospect of doing IVF with 43 year-old eggs, would gladly trade positions with the woman using 38 year-old eggs.
Second, fertilizing your eggs, and creating embryos, gives a much clearer indication as to whether your investment will lead to a live birth. A PGS-tested embryo that comes back normal will lead to a live birth in nearly 70% of circumstances, regardless of how old a woman was when she made that embryo. This step will raise your level of certainty, help you plan for the future, and possibly save you from doing additional cycles. Making embryos is not without its costs, namely procuring donor sperm ($1,000 - $5,000), performing PGS ($5,000), and, importantly, foreclosing your ability to inseminate those eggs with a future partner. An increasingly popular solution is to inseminate half of the eggs retrieved to hopefully get a few good embryos along with a better sense for how good the remaining eggs are likely to be.