To Freeze or not to Freeze

Social egg freezing, affectionately known as “Eggsurance” by some, is a process whereby a woman has her ovaries stimulated by medication and then goes through an in-vitro fertilisation (IVF) cycle to collect eggs. These eggs are then cryopreserved using a technique called vitrification that avoids ice formation within the egg. They are then cooled to below the freezing point of water.

They are thawed at a later stage when an embryo is to be made, either with a partner’s sperm or donor sperm. This embryo is then placed back in to the uterine cavity with the hope of a subsequent pregnancy.

Oocyte (egg) cryopreservation is also used to preserve fertility in women undergoing treatment for a medical condition that may damage fertility or reduce the chance of natural conception. 

Increasingly women are considering egg freezing whilst traversing the obstacle course of adulthood, establishing their careers and forming a romantic partnership. The COVID pandemic has highlighted several barriers to meeting a partner and having a family. In fact, rates of IVF have increased due to less travel, changes to work practices and perhaps a renewed perspective on mortality and family. 

When considering the costs of egg freezing, one should consider not only the financial but the social costs and the impact of pregnancy later in life on the individual woman and the child born. The majority of egg freezing cycles are not covered by Medicare. The number of cycles required to obtain the suggested 20-30 eggs varies due to egg reserve and the age-related impact on egg quality. 

For those women using their cryopreserved eggs in the future, the eggs generally behave the way you would expect for the age at which they were frozen. When counselling women on outcomes of pregnancy as a result of egg cryopreservation, the age at which the pregnancy occurs should be factored in. 

The Likely Candidates?

Women between 30-37 are encouraged to consider egg freezing and should take into account factors such as family size expectations, age, career aspirations, finances, relationship status and whether an opportunity exists to meet someone that shares similar family desires and whether there is a family history of premature menopause.

The patient’s perspective (a half glass full or empty approach to life) factors into how a woman may view fertility and egg freezing. Some women may prefer a watch-and-wait approach having considered their options. Some are comfortable with having a sperm donor if they don’t meet someone they wish to have a family with and, as a result, may be more proactive in oocyte cryopreservation.

Social media and ‘celebrity baby stories’ have impacted how women and, indeed couples, view fertility. What is often not discussed is the older woman’s journey to have a baby (e.g. several rounds of IVF miscarriages, use of eggs cryopreserved at a younger age or egg or embryo donor). 

In an age where women aspire to higher levels of education and are driven to have successful careers and being financially independent, there are questions as to whether egg cryopreservation devalues women in the workforce. Some argue it detracts from support for women who have had children rejoining the workforce. 

Some global companies (e.g. Google, Apple and Facebook) offer egg freezing to their employees as a perk. Is this a forward-thinking move to give women a choice or a way to delay childbearing to enhance productivity; and how does this affect career trajectory if opting in or out? 

Companies in the United States have been set up to host egg freezing parties to educate young women on the benefits of egg freezing to ensure that they have the option of having a child when they feel ready (usually later in their 30s or 40s) when their careers are established.

This begs the question as to whether it preys and capitalises on a woman’s anxiety regarding having a child as she ages.

Currently, eggs can be preserved for 10 years in Western Australia and the latest data shows that only 10% of women who freeze their eggs use them in the future. Some decide to have a sperm donor or meet someone and fall pregnant, hence their eggs are not used. Others choose not to have a child but still appreciate having had the option. 

If eggs are not used the options thereafter can be to allow them to thaw and succumb, donate to research or donate to another woman. 

In the future, we may be counselling women on preserving a portion of their ovary with the hope of preserving thousands of eggs, which could be available for fertilisation if and when a woman decides to have a child. This may negate the need to undergo hormonal stimulation to obtain eggs for future use and reimplantation of ovarian tissue may reduce the impact of menopause for women of the future. 

My patient or I want to freeze my eggs. What next? 

So, your patient, or perhaps you, have read everything there is to read on Google, blogs, and social media. The next step is to review preconception health with your GP and refer to a doctor in the area of Fertility Medicine. 

At this consultation, general health is reviewed and the reasons for seeking fertility preservation explored. A test of egg reserve and baseline fertility bloods are usually conducted to give each patient an overview of their reproductive options. Then a decision can be made to go ahead with oocyte freezing or review the patient’s circumstances at a later time. 

The psychological impact of discussing the likelihood of having a child in the future cannot be underestimated and a supportive team of doctors, nurses, fertility counsellors and, if necessary, a psychologist, is available if extra support is required. Patients are encouraged to speak to those close to them for emotional support. 

Egg freezing can create a false expectation that it will guarantee having a baby in the future. As a society it also raises questions as to the value that we place on women and the subliminal expectation that women should and are expected to have a child to fulfill their “womanly obligations”. 

Like all choices, the option should be available to women regardless of their income and childlessness should be, and is an acceptable lifestyle choice.