Suddenly, it seems, everyone is singing the praises of oocyte cryopreservation -- or what must of us call egg freezing -- as the latest cure for a woman's declining fertility. But egg freezing isn't quite the panacea the media would have you believe, and it turns out, all this coverage may be pushing an individualized solution to a deeper systemic problem.
Take Sarah Elizabeth Richard's recent Wall Street Journal article, "Why I Froze My Eggs (And You Should Too)." Never mind that Richards, author of a new book, Motherhood, Rescheduled, hasn't yet used any of the 70 eggs she's banked to try to have a biological baby. She still firmly believes that the greatest gender equalizer for women is the $50,000 she spent on freezing her eggs, for what she calls the psychological relief of having baby insurance -- not career conscious movements like "leaning in," or more family flexible policies like telecommuting and increased maternity leave.
"There is no question that the media is hooked on social egg freezing," said Diane Tober, a medical anthropologist and associate director of the Center for Genetics and Society in Berkley. It makes a great story, explained Tober, because they're framing it through a "feminist lens": that egg freezing is going to be "the big game changer" for women who want to have it all and break through their biological barriers.
But the real game changer for professional women, according to Tober, is a level playing field in the workplace -- to become a society that supports flexible work environments and family leave policies, and provides better, quality childcare -- so women actually can have children in their peak fertility years. Unfortunately though, for the media, this lacks the appealing personal narrative of egg freezing. At a friend's baby shower for example (as Richards describes her own emotional journey), it's certainly more comforting to know that your eggs are "safely" frozen away so you can have your baby when you're ready, than to argue that American companies should institute longer maternity leaves and more flexible work arrangements.
"A lot of women, especially affluent women, are perpetuating the myth in the media and telling younger women, if you freeze your eggs, you won't have the pressure of finding the right partner," Tober said. But while they're framing the issue as an extension of choice, the truth is, at $7,000 to $10,000 a round, plus storage fees, only a fraction of adult women would ever have this choice (even if, one day, insurance companies or employers picked up part of the tab).
The rest of the female population, meanwhile, remains stuck in a work place that still doesn't adequately support families and mothers -- a public dialogue that can easily be lost when the media is telling women how easy it can be if we all just freeze our eggs. And then what's going to happen to these women at 45 when they try to continue their career and raise a newborn? Nothing, materially, will have changed since they were 36, unless they're all planning on a corner office with an adjacent nursery, like Marissa Meyer built, to accommodate their babies and nannies.
At the same time, there's also the potential for an odd, egg freezing dichotomy and wealth divide, between the women who can afford to freeze their eggs to pursue their careers, and the women in their twenties who may soon be able to sell their eggs for medical research. A new bill under consideration in the California legislature and sponsored by the American Society for Reproductive Medicine, AB 926, would allow researchers to pay women cash for their eggs, overturning the existing National Academy of Sciences guidelines. Proponents of AB 926 argue that the bill promotes social equality by offering "fair compensation" to women and "treat[ing] them equally to other research subjects."
Tober believes that the media is missing the other half of the egg freezing story -- that women who sell their eggs aren't like traditional subjects in clinical trials. Researchers aren't studying their reactions to experimental drugs or procedures. They're seeking a woman's raw material for scientific work, eggs that (unlike sperm donation) require high doses of hormone shots and a medical procedure that can result in health complications to harvest. So, while you have privileged, professional women electively freezing their eggs on one end of the spectrum, AB 926 creates a real risk -- that low-income women and college students under financial pressure will be enticed to sell their eggs for science -- on the other.
"Egg freezing is seen as this big revolution now, like the Pill was for reproductive rights, women's health, and family planning in the 1960s," said Dr. Frederick Liccardi, a fertility expert and OB/GYN at NYU, who says about 20 percent of his patients now request oocyte cryopreservation, in large part, he believes, because of all the positive press. But egg freezing, he reminds patients, isn't like the birth control pill yet (in terms of cost, relative ease, or outcome), and women need to understand that while it may feel empowering to freeze their eggs, it's far from a foolproof method to optimize career success and family planning.
"I think the media is fascinated with this," Liccardi explained, "because as many great steps as we have made in our society, this is first method of female empowerment that feels really big and new in a long time."
But a woman's egg is only one part of the fertility equation. Dr. Irene Su, a reproductive endocrinologist and clinical researcher the University of California, San Diego, works primarily with breast cancer survivors and patients interested in medical freezing. "No matter how old the woman, whether they've had cancer or not," said Dr. Su, "the chances of success of egg freezing and implementation and ultimately a viable pregnancy are about the overall health of the mother. It's a bigger picture than just when and if you froze your eggs." Regardless of the age of a woman's eggs, those who get pregnant later in life have a higher risk of high blood pressure, diabetes, pelvic inflammation, placenta previa, miscarriage, and early delivery because of preeclampsia.
The media is also ignoring the very real issue of how cost-effective egg freezing actually is for women in their mid to late thirties (assuming they want to thaw their eggs after age 40) -- and how much each year makes a difference, much like it does for natural fertility rates, where a woman's chances of becoming pregnant decrease by 15 percent annually after age 35.
Dr. Nicole Noyes, co-director of the NYU Fertility Center and professor at the NYU School of Medicine, studied 900 women, asking: is it more cost-effective to freeze your eggs before you're 40, than to arrive at a fertility clinic at 40 to freeze your eggs or try in vitro fertilization for the first time? Noyes and her research team constructed a model, presented as an abstract in the journal Fertility and Sterility, to determine whether egg freezing is a cost-effective method of treating age-related infertility, as measured by live birth success rates from previously observed clinical practice.
Noyes found that for women younger than 39 who were delaying childbirth, egg freezing alone (with no other fertility measures) was a cost-effective means of increasing their likelihood of having a biological child. Freezing after 39, however, was not cost-effective compared to multiple rounds of IVF. Women who froze their eggs between 30 and 35 had a 61 to 72 percent chance of successfully having a baby, at a cost per live birth of $34,221 to $43,408. But egg freezing after 37 or 38 starts to look less compelling, according to Noyes's data, with success rates falling to as low as 42 percent, and the cost per live birth rising dramatically to as high as $74,564 by age 40.
"Of course for most women I see," Dr. Noyes said, "the issue isn't about money. It's about having a healthy baby -- and that's really all they care about." And those, it seems, are the only stories the media finds worth telling.
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