By Susan Carroll
WWR Article Summary (tl;dr) This article out of Houston takes a look at the option of freezing your eggs. For patients without insurance coverage, Houston IVF charges about $10,000 for the initial procedure, including medication and two years of egg storage. It costs $300 per year for storage after that. Fertilization and embryo transfer is an additional $7,000. We hope this information helps with empowering women to make decisions that fit their lifestyles.
Carol Plasencia knows she wants to have babies. Two, at least.
Just not right now.
Plasencia works as an inventory manager for a safety company. She is months from finishing a bilingual education degree and says she wants to spend the next few years focusing on her career.
But she faces constant reminders about her biological clock and how fast it’s ticking. Her fiancé is pressuring her to start a family right after their January wedding. And her niece recently drew her a picture of eggs with sad faces and scrawled “YOUR EGGS ARE DYING!” across the page.
“I’m 34. On the brink of 35,” Plasencia says. “The magic number.”
As more American women delay having children — either to avoid the “mommy track” at work or to wait for Mr. Right — they are confronted with a simple fact: Fertility starts to significantly decline around 35.
Some women, like Plasencia, are considering an increasingly popular but costly option to delay having babies — egg freezing. On a recent Tuesday night, Plasencia and a girlfriend went to an “egg freezing party” at a painting studio in the Heights hosted by Houston IVF.
“If you’re not ready for children just yet, egg freezing gives you the freedom and peace of mind to pursue other dreams without giving up your dream of someday starting a family,” the advertisement on Facebook read.
Dr. James Nodler, a doctor with Houston IVF, explained the procedure to 18 women as they snacked on hors d’oeuvres and sipped white wine.
“We are preserving the eggs at the age and quality they are now,” he said. “So if you’re 34 years old, potentially these eggs can stay 34 years old forever and keep the same quality as a 34-year-old’s eggs.”
‘Not a guarantee’
Egg freezing is not new. The first human birth from egg freezing was reported in 1986. The procedure was initially offered to cancer patients facing chemotherapy and radiation, which can lead to early menopause.
Back then, the process involved slowly cooling the eggs, which often resulted in crystal formations that damaged them. In 2003, researchers started using a new process called “vitrification,” which cools the eggs so quickly that they become “glass-like.” That drastically improved the procedure’s success rate, Nodler said.
In 2012, the American Society for Reproductive Medicine lifted the “experimental” label for the procedure but warned that there was insufficient data on the safety, efficacy and cost-effectiveness of egg freezing to endorse its widespread elective use.
“Marketing this technology for the purpose of deferring childbearing may give women false hope and encourage women to delay childbearing,” the ASRM panel warned then. “In particular, there is concern regarding the success rates in women in the late reproductive years who may be the most interested in this application.”
Nodler told the women at the painting studio that success depends in large part on how many eggs the doctors can collect. Women are given fertility injections leading up to the harvesting procedure, which is done under sedation at the doctor’s office.
“If someone is under 35, we typically expect to get 13 to 16 eggs per cycle,” he said. “If someone is between the ages of 37 to 40, typically we’re getting about 8 to 10 eggs per cycle. As you get older, 41-44, we’re going to get 6-9 eggs per cycle.”
The extracted eggs are then frozen in a lab and can be defrosted when a patient decides she’s ready to have a baby. Once the eggs are thawed and fertilized with sperm, doctors can select embryos to implant. Depending on the patient’s age, a doctor may implant just one or several.
Some eggs may be lost at different steps in the process, Nodler said.
“It’s important to say that doing this process is not a guarantee of having a child,” he said. “And that is something any physician should tell you. What we’re trying to do is increase your odds of success. Is it an insurance policy? No. It’s not 100 percent, and nothing is.”
Understanding the odds
Marcelle Cedars, director of the Center for Reproductive Health at the University of California, San Francisco, said in an interview that the estimated live birth rate per egg frozen under age 35 is 10 percent to 12 percent. For someone closer to 40, the range is more like 6 percent to 8 percent, she said.
Since multiple eggs are typically frozen, that increases overall odds of success. A review of several recent studies showed the live birth rate if a women has six eggs frozen and thawed is 31 percent at 25 years old and 13 percent at 40, Nodler said via email.
Researchers are still trying to understand what makes older women’s eggs particularly vulnerable during the freezing process, Cedars said.
She explained that chromosomes in an unfertilized egg are lined up on what is called a “spindle.” As women get older, she said, the spindle becomes more unstable, which can lead to an increased risk of genetic abnormalities, like Down syndrome.
When an egg is frozen and then thaws, the chromosomes have to realign on the spindle, increasing the odds of a problem.
“It’s an incredible technology, but I think sometimes people give it more credit than it deserves,” Cedars said. “The one thing we haven’t been able to overcome in reproductive medicine is the aging ovary and the aging egg.”
Cedars said patients typically overestimate their chances of success and are surprised to learn the statistics.
“I struggled with this for a long time because I was concerned we were putting a lot of women through a procedure that they didn’t really need because probably most women will never use these eggs,” Cedars said. “But I’ve had enough women convince me that from a psycho/social standpoint, it gives them some peace of mind. They say it’s like having car insurance.
If you have car insurance, you’re not upset that you never have a car wreck and you never use it.”
A spokesman for the Centers for Disease Control said the agency started tracking egg banking data earlier this year, though it is not yet available.
“The tricky thing is that so few of the women who have frozen their eggs have come back to try to fertilize them to create embryos,” said Dr. Timothy Hickman, Houston IVF’s medical director.
He said the center has performed 150 egg freezing procedures, but only 21 women have tried to get pregnant. Ten of the 21 succeeded, he said, though two later miscarried. Two of the patients are still pregnant, he added. The remaining six had babies.
Insurance companies generally don’t cover elective egg freezing. A few employers, including Apple and Facebook, announced in the past few years that they would pay for the procedure.
For patients without insurance coverage, Houston IVF charges about $10,000 for the initial procedure, including medication and two years of egg storage. It costs $300 per year for storage after that. Fertilization and embryo transfer is an additional $7,000.
Plasencia said she and her fiancé, who is 29, talked over their options when she came back from the party.
She made an appointment for March 24 to have her egg count measured — the first step in the freezing process.
If they don’t do it this year, she said, then they probably will next year.
“I wouldn’t mind being 40 when I have my first baby,” she said. “That would give me plenty of time to have a stable marriage and to have worked a few years.”
She said she appreciates her fiancé’s concern about her age and the health of her eggs.
“It’s very sweet of him,” she said, “but no one is going to tell me when to have children.”