Until very recently, intended parents had only the option of freezing embryos. If you were single, this meant you had to select a sperm donor to create those embryos and this would foreclose the opportunity to build a family with a future partner. If you were partnered, freezing embryos was a commitment that could go beyond the end of a relationship and could require that a woman might have a genetically related child with a partner that was no longer part of her life. Additionally, many intended parents were forced to grapple about what to do with their frozen embryos if they chose not to use them.
Today egg freezing is an increasingly viable option and has parity of success rates with the option of freezing embryos. When I work with women and men who are facing this decision, I counsel them to separate the issues about whether to freeze eggs or embryos into the practical and the emotional. Both parts of the decision are important. When they get mixed up together, individuals run the risk of making a choice that doesn’t account for all of their needs.
Let me give you an example. A young patient of mine was about to start a treatment regimen for her cancer. She had been dating her boyfriend for about 18 months and the relationship was going well despite the stresses of the newly diagnosed cancer. The young woman was uncomfortable creating embryos because she didn’t know what she would do with any extra frozen embryos if she didn’t use them. As we discussed her situation, she was focused on the practical issues of success rates and what to do with any extra embryos. She had not allowed herself to consider her disquiet with the possibility that the relationship with her boyfriend might not continue to grow and that having embryos would limit her family building options because she would not have eggs to use with a future different partner. Acknowledging those fears was an important part of her decision making and led her to choose the option of freezing eggs; this took the pressure off of her as well as off of her relationship.
By exploring and understanding both sets of issues, intended parents have the ability to weigh all of these factors, much like an old-fashioned “pros and cons” list. For this exercise, each person makes a list regarding the issues surrounding egg and embryos freezing, with “practical” issues on one side and “feelings” on the other. For example, here is an example of one such list:
Weighting this list can be the next part of the exploration. On each side, I encourage each person to measure the importance of each item entered on the list so that each side adds up to 100. This allows each person to have some perspective of how important, or unimportant, the issues are to them. This is not the scientific part. This is the part where you let the feelings loose and not tidy them up.
If you’re going to share this list with a partner it’s helpful to do this at a time of day when no one is too tired or does not have time. It’s important to share both your feelings and the concerns you may have about sharing those feelings. Both partners need to agree to listen, not interrupt, and be open. Use the tried and true communication skill of listening and then stating back what you heard. Your partner then has the opportunity to say “you heard that correctly” or to say “you heard many things correctly but let me try again with these points”. And then repeat the communication exercise. It may be awkward but it’s effective.
This exercise is meant to help the individual gain deeper personal understanding of how s/he is thinking and feeling about these issues. The exercise also allows the opportunity to talk about the very emotionally charged issues in the future: for partnered individuals to talk about the possibility that they might not be together (for divorce or for death) and for unpartnered individuals to foreclose family building options with a future partner. Issues of loss, conflict, disappointment and fear are all intertwined in these discussions.
Don’t be afraid to be messy, honest, confused and scared. Be strong and jump in and try to consider as much as you can. I often tell the women and men I counsel that this discussion is like trying to understand a three dimensional object with a two dimensional tool such as a camera. So keep taking pictures as you walk around that object as much as possible. And, if there are two of you, remember that you may be taking pictures from different places and work to make sense of it together.
It’s hard to be 100% certain about any decision. When you get to the point where there is no new information and you've had the chance to communicate fully about the decision, then it’s time to make your best informed decision. If both partners are not on the same page, which happens often, then it’s best to make the decision that has the least long term consequences of either A. foreclosing options or B. eliciting a sense of regret; this is often the choice to freeze eggs. As one man told me, “I will be devastated if we never have children. But I would have a lifetime of regret if we had children that we didn’t raise together.” For this couple, they were happier freezing eggs. Conversely, another partner said to me, “Sometimes you have to jump in with both feet. If we never had children I could not live with the ‘what if’.” He and his partner chose to freeze embryos.