7 minute read
BABY STEPS
Confronting the shame of not having children with the rest of your friends, and when to think about egg freezing.
BY DR. LEA LIS
It’s hard to pick the “right” time to start a family. As women age, they’re less fertile, so freezing eggs as early as possible gives them the best chance to conceive when they are ready. Women are beginning to have children at much later ages, according to a recent study published on the news and research website The Conversation: “By age 25, two-thirds of high school-educated women had a rst birth, but it takes until age 35 before two-thirds of collegeeducated women have had a birth.”
Not all women delay having children. The national average age at which women give birth to their rst child is 26 years old. As the baby shower invites start pouring in during a woman’s late 20s, many women who have not yet started families of their own begin to feel shame and worry about keeping up with their peers.
So does egg freezing work, and is it safe? Dr. Fahimeh Sasan, OB/GYN, states that egg freezing has been well studied, as it is similar to IVF. There is no-to-minimal risk to a woman’s body, in terms of increased risk of breast cancer or other medical issues. Prior to 2012, the process of egg freezing was considered experimental. Eggs are much more fragile than embryos. However, the process of vitri cation, a ash-freeze process, allows doctors to freeze and thaw eggs as safely and effectively as they are able to freeze and thaw embryos. Today, egg freezing and embryo freezing are equally effective. The major factors that contribute to the success of both egg and embryo freezing are the age of the woman, the number of eggs available and the time frame in which the eggs are used.
Rebecca Silver, vice president of brand marketing at Kindbody, a fertility, gynecology, and wellness company with boutique clinics across the country, told me the average cost of egg freezing is $6,500. This price does not include the hormone medications that are necessary for stimulating ovaries to produce enough eggs for the retrieval. The hormone medications can cost an additional $3,000 to $6,000, depending on how much is needed. The medication often ends up costing more for older women, as a greater supply of hormones may be required to achieve desired retrieval results. On average, egg storage is $600 per year (low end). You may be able to use money in Health Savings Accounts or Flexible Spending Accounts to pay for egg storage, which makes it tax free. Doctors typically point to 35 as the age at which fertility seriously declines, but Silver told me that 10 percent of people under the age of 35 have primary ovarian insuf ciency. She encourages everyone to proactively get a fertility assessment to understand their own fertility health, and to learn how their egg reserve compares to what is standard for their age. A fertility assessment includes an ultrasound of ovaries and a simple blood test for the anti-Müllerian hormone (AMH), which is one of most reliable measures of ovarian reserve. The results of
The safety of a woman’s eggs is preserved through a flash-freeze process called vitrification.
the assessment will help you understand how your fertility compares to others your age, and if and when you should consider egg freezing. The assessment also includes a consultation with a physician, who will ask you about your own family-building goals and take that information into account when making a recommendation. Silver generally encourages women to freeze their eggs when they’re younger, but this cost—typically $10K minimum—can be a major barrier to many women in their 20s and early 30s. Such a steep nancial undertaking should bring years of peace of mind, but how many years does egg freezing really buy? This answer differs on a case-by-case basis.
Freezing eggs earlier than age 35 depends upon a number of factors, such as ovarian reserve indicators that can signal premature ovarian insuf ciency (which can be tested), family history of early menopause (under age 45), genetic testing for Fragile X syndrome, endometriosis and polycystic ovary syndrome (PCOS). Additionally, any type of cancer diagnosis (because chemo and radiation harm fertility) and autoimmune disorders (such as lupus) are also considerations for early egg freezing.
According to a journal article titled “Optimal Time for Elective Egg Freezing,” if you decide to freeze your eggs at 25 years old but end up conceiving naturally a few years
later, freezing your eggs is a waste of time, money and effort. So what is the optimal time for actually using the eggs you froze? According to some experts, the answer is 37 years old. You still have enough genetic coins in the bank to spit out some robust eggs. The Conversation reports that only 17 percent of those who freeze eggs for social reasons actually use the eggs to give birth. The earlier you freeze the eggs, the less likely you will use them, as you may get pregnant naturally. The older you get, the more likely you will use them as your fertility rate goes down. Looking deeper, you could get the best eggs and the best preservation of your genetic material, which would be the most likely to fertilize later, at 25. But for those who’ve recently joined the workforce, average income may be around $40K per year—hardly enough available disposable income to consider egg freezing if your insurance or employer doesn’t foot the bill. But let’s say at age 30 you are making $49K, and at 35 you are making $70K. Then, 35 might be an optimal year for egg freezing. In this scenario, you make enough money to afford it. If your company provides egg freezing bene ts, then it’s not your money wasted if you don’t use the oocytes. So if your company gives you the bene t, it may change the cost/bene t analysis of egg freezing at a younger age. Another consideration is the family size. It might make sense to freeze eggs if you want a second or third child, and are putting it off until after 35.
Ellen Hukkelhoven, managing director at Perceptive Advisors, is one of those women who took the plunge to freeze her eggs. “I did two egg freezing cycles,” she told me. “One when I was 26 years old. I got 31 eggs that time. I did it again when I was 34, and got 16 eggs. I did it not because I was certain I wanted to have children, but because I wanted to preserve optionality. Freezing my eggs empowered me to make every decision, both professional and personal, just like a man. I felt no pressure to nd a partner quickly in order to have children. It really levels the playing eld for women, and gives you this amazing con dence that is very hard to describe. I know I have the option to have children for many more years than I would have, otherwise.”
For another perspective, I talked to Megan McGill, M.D., Ph.D., and VP at BridgeBio. She had a child in her 20s, but now, with a new partner, she is trying again and was disappointed by the egg freezing process. She froze her eggs at
NYU at age 34. She had 22 eggs, 16 of which survived the freezing. Six years later, six eggs survived thawing, four were fertilized, and none grew into embryos. Now, at 40, she has to undergo IVF to start the process again. “If you are sure you want kids,” she says, “then have them before 35; otherwise, it’s always a high-stakes calculation.”
Men aren’t off the hook on this one, either. The earlier men freeze their sperm, the better chances of conception and having a healthy baby. This procedure is relatively inexpensive and low maintenance (although you’ll have to pay yearly fees for storage). Conceiving with a man over 50 years old (advanced paternal age) may result in children with a higher risk of genetic disorder or conditions like autism spectrum disorder, due to very small mutations called single point mutations. So, all men should freeze sperm if they want to delay having children.
For women considering egg freezing, getting a professional consultation might help you think through all the factors I outlined above—age, amount of children, risk factors to fertility—so when the baby calls, you can be ready.
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