So, you're thinking about "having it all." Great! Unfortunately, your body might not be as amenable to your professional schedule as you'd like. A woman's fertility is finite and needs to be addressed during the years that are most crucial to career development. It's one of the more annoying snags in the corporate casual pantyhose of feminism. The good news is that, through egg-freezing, science has enabled us to press the snooze button on our biological clocks. But how viable of an option is it really? And can you even afford it? Here, we tell you everything you always wanted to know (but were afraid to ask) about establishing an "egg-surance" policy.
The American Society for Reproductive Therapy recently lifted the "experimental" label from egg-freezing, declaring that the technique is now safe, effective and standard. However, when they lifted the label, they did not endorse "social freezing" (the industry term for elective egg-freezing in order to delay motherhood).
"The reason they didn't endorse it is because they are very concerned that people will overestimate the benefits," says Dr. Daniel Shapiro, Medical Director of Reproductive Biology Associates and Clinical Manager of My Egg Bank North America, "They don't want patients to have an unreal expectation of what egg freezing will do for them."
Dr. Shapiro, who helped pioneer rapid egg-freezing technology in the U.S., broke down the out-of-pocket expenses and walked us through the process. But first, there are some things to know before getting started.
The ideal candidate to egg freeze is actually in her 20s. "Once somebody gets past 30, it still may be a perfectly reasonable thing to do," Dr. Shapiro tell us, "We've had somebody as old as 41 have a pregnancy with her own frozen eggs, but generally speaking, once you get past 36, 37, the chance that this is going to be a reasonable insurance policy is not very good."
Women up to age 35 can expect a 50% chance that her eggs will be functional to make a baby. Women 36 - 38 have about a 35%. Most IVF programs report pregnancy statistics of about 15% - 20% per attempt in women 39 - 41 and freezing one's own eggs at that age won't improve those chances. "People who are looking to delay fertility at 40—it's too late," says Dr. Shapiro.
The amount of time involved in harvesting eggs to freeze depends on two things: how many eggs an individual can produce per attempt and how many children she wants to have. "The first question we always ask when somebody comes in is, 'How many kids do you want?'" says Dr. Shapiro. "If somebody says they just want one child then they probably only need to do one egg freeze. If they say, 'Well, I want to build my whole family from this,' then it becomes immediately obvious that we will probably have to do more than one retrieval."
Dr. Shapiro estimates that from each group of six eggs there will probably be one reasonable attempt at pregnancy, so hopefully a woman will yield at least six eggs per retrieval. Ideally, you'll want to retrieve 20 eggs on your first attempt so that you won't have to do it again. However, the average retrieval yields 10 - 13 eggs.
Each attempt will take about 9 - 13 days of self-administered medication, with ultrasound monitoring every few days, meaning you will probably miss a few hours of work due to doctor's visits. Two days after the medication cycle, the eggs will be collected in the doctor's office, and will require you to miss a day of work. In all, it's about two weeks worth of time per attempt.
Because insurance companies do not cover egg-freezing, all expenses must be paid out of pocket. The prices for egg-retrieval and -freezing varies throughout the country—being more expensive in larger metropolitan areas, for example—but no matter where you live, it will set you back tens of thousands of dollars.
The drugs are particularly expensive and tailored to one's own hormonal needs. One Gonal/f pen—a pre-measured injection of follicle-stimulating hormone (FSH)—will set someone back $900 a piece, and they could need up to three a day.
On the low-end, it will cost about $10,250 just to take the drugs, collect the eggs, and open your account at the egg bank. The high-end will be about $22,750. And those prices don't include the cost of yearly storage or the cost of thawing and insemination.
Say you freeze your eggs when you're 30 and want to thaw and inseminate when you're 40. From beginning to end, the cost of one pregnancy will set you back $20,250 - $32,750. And that is if you managed to get the amount of eggs you needed with just the one attempt. Tack another $10,000 - $20,000 on to that price for each egg collection. The whole process could cost upwards of $50,000. Many facilities have financing programs to help patients afford its services.
The biggest risk with egg-harvesting and -freezing is something called ovarian hyperstimulation syndrome (OHSS), a complication of fertility medication. The younger you are, the more likely you are to get it, and while it is treatable, there is a risk of death. (Although Dr. Shapiro says that "death is rare as all get out.") OHSS will pop up a week after the harvesting process, but it is preventable through monitoring, and when picking out a facility to collect eggs, patients should ask about how their health will be protected in this respect.
Step 1: Testing
In order to determine how many eggs she is likely to make, a woman will need an anti-Müllerian hormone (AMH) test. "This test is really key," says Dr. Shapiro, "Because it tells us whether they're gonna make a lot of eggs, a medium number of eggs, or not so many. If they're under 30 and they have a high AMH or a medium AMH, then yes, this makes some sense if they're really set on delaying fertility indefinitely and they want an insurance policy. If they AMH is really low at any age, it means that the cycle is probably not gonna go as well as people want it to. We warn people up and down that it may not be in their best interest to spend the money to freeze what's available with a low AMH."
Step 2: Medication
Once it's determined that a woman's AMH level is indicative of a good ovarian reserve she will be put on a fertility meds of daily injections, up to three times a day, for 9 - 13 days. Side effects that women could experience include: weight gain, abdominal discomfort, bloating and irritability. Because you're producing so many eggs, it's like getting a year's worth of PMS all at the same time.
Step 3: Monitoring
During the 9 - 13 days of the medication cycle, a woman will have to visit the doctor's office twice weekly to monitor her stimulation with vaginal ultrasounds and blood work. This will let the doctor know how she's progressing and whether or not her medication needs to be altered.
Step 4: Collection
The eggs are collected 36 hours after the last injection of the medication cycle. The patient is put in a twilight sleep from an IV. "It's sort of like getting a major procedure at your dentist's office," says Dr. Shapiro. "You're breathing on your own but you're out of it."
The eggs are "sucked out" with a long needle that goes through an ultrasound probe that is inserted in the vagina. The probe enables the doctor to see the follicles, the sacs that the eggs are in. The doctor will then pop the needle in and suck all the fluids out and the eggs come with it.
The patient will have to take off work for the day, because she'll be too groggy from the medication to even drive herself home. Dr. Shapiro says that his center will not do the procedure unless a patient's "support person" is there to take her home.
Step 5: Freezing
After the eggs are collected, they will be frozen and stored in an egg bank. It typically costs $500 to open an account at an egg bank and then around $250 per year, until she decides she wants to thaw and inseminate.
Step 6: Thawing & Insemination
Once a woman decides she's ready to start her family, it will cost her around $7500 to have her eggs thawed, inseminated, cultured, and inserted back into her. It's the same as any other IVF procedure. Dr. Shapiro says that the drug protocol for this portion is "very inexpensive and fairly short" and is possible with no drugs at all.
As far as the chances of a pregnancy go, Dr. Shapiro says, "A woman who chose to freeze her eggs at 32, there's a 50% - 60% chance every time they put an embryo or two back into their uterus. So somebody like that is probably gonna pregnant within three attempts of thaw and transfer."
That depends on the woman, how much money she has, and how important it is for her to have her own biological children.
And despite the technology being there, not many babies are born from these types of "egg-surance" policies. Is this because women have only just started to investigate this as an option? No, says, Dr. Shapiro. "There have probably been 3000 - 5000 social egg-freezings per year over the last four or five years, so about 20,000 cycles total since 2006—but only a couple hundred babies," he explains, "And that's mostly because the women haven't come back to use their own eggs."
There are a number of reasons, he says, that women end up not getting pregnant from their frozen eggs. Some of which are:
1.) They decide they don't want any kids after all.
2.) They don't get married and they decide they don't want to be a single mom by choice.
3.) They do get married and they get pregnant on their own and they don't need their eggs.
4.) They did try their eggs but it didn't work.
(The last is "not a big group," according to Dr. Shapiro, but "it happens.")
Egg-freezing doesn't seem to be a solution to delaying fertility as much as it is an option that might increase, but not guarantee, one's chances of getting pregnant later in life. And having options is good—if you can afford them.