The subject of childbearing readiness is likely to be one of the more emotionally charged mother/daughter conversations. So before making any remarks about ticking clocks or Prince Charming’s delayed entrance, you should have the facts, stats, and be prepared for drama and tears.
We asked one of our favorite OB/GYN’s Suzanne Gilberg Lenz, a doctor with heaps of science and wisdom in her toolkit to unpack this thorny subject.
Can you demystify the process a little bit? What exactly is “egg freezing?”
Egg freezing is a method used to preserve a woman’s reproductive potential. Eggs that are taken from women’s ovaries are harvested, frozen, and stored at a constant temperature until needed. Egg freezing is also the first step in the IVF process and begins similarly, with evaluations of the uterus, hormones, and general health. Hormones are then prescribed to over-stimulate the reproductive system – instead of one egg each cycle; hormones encourage the body to produce many eggs. Before your body tries to ovulate the new eggs, the doctor goes in with an ultrasound vaginal needle probe and sucks them out. The eggs go straight into the deep freeze. Stats for the eggs that survive are somewhere between 4 and 14%, which is why you want to get as many eggs as possible. Later on, even if you pick the perfect egg to implant, it may or may not result in a live birth. Although the process isn’t terribly risky, it’s also not foolproof, but it’s better than being 43 with no other options.
Okay, I get it. Now let’s begin with “when?” When should we start the conversation?
Of course, the younger, the better, but this is where it gets challenging–we don’t really have an exact way of telling if women are fertile. The number 35 has come up a lot as a watershed year for women trying to conceive and even that number keeps being disputed. Fertility rates appear to decline at age 35, but that stat is based mostly on age. None of the other demographics like weight; smoking, stress onset of menses etc. are taken into consideration, so a lot of us aren’t even certain if that number is accurate.
Where does the subject begin? Can you give us a conversation starter?
Better to ask your daughter if she wants a family and if she wants to have a family on her own or with a partner? And then ask if she wants more than one child. If she is 35 and wants more than one, she better act with a little more certainty.
Women in early 30s need to start thinking about this. Not freaking out, because stress doesn’t help with fertility, but if a woman knows she wants to have kids, she needs to start putting some thought into when, with whom and how. If she gets to 34 and still isn’t certain –that is the time to seriously think about freezing eggs.
Is it wrong to suggest an early evaluation so that she knows what she’s dealing with?
Basic fertility evaluations can be done at any age, it’s an easy blood test but it isn’t definitely predictive. It’s just a snapshot.
When should we worry about it?
Never. It’s never helpful. I want everyone to take a deep breath. Between 35 and 40, you need to get on it.
How much does this cost?
The cost depends on where you live. What we’re talking about is – egg freezing — or first portion of an in-vitro cycle. The first stage costs include a visit with a fertility doctor, hormonal stimulation, which is essentially the cost of drugs, and then the retrieval process. The candidate must overproduce eggs for one cycle, and then they do the retrieval process, which is a minor procedure. 5-10k dollars assuming you get a great response the first time. If you produce just four eggs, you have to have another conversation and perhaps, repeat the process. If you get around to using these eggs, then you are committing to IVF, which involves a lot more expense.
How long can they last in freeze?
The problem is that we don’t have that much data. We haven’t been doing this for all that long. We have data on embryos, defrosted and live births up to 12, 13, 14 years, but just not enough data on eggs. The freezing methods in just the last few years are much more sophisticated than eight years ago. Going forward, there is going to be a much more successful thaw rate.
It feels like this came out of nowhere – is it because of the rise of IVF?
Egg freezing technology grew around trying to spare young people with cancer from the sadness of infertility, and it evolved from there.
Success rate?
Depends on the quality of the eggs, and the number of the eggs. The newest stats suggest that if you are 35, you’ll need 17 eggs to result in one live birth. Age isn’t the only factor but it is likely to be the largest factor.
Are there any dangers involved that we might not think or know about?
The risk is hormonal. There can be ovarian cysts and pain. Risks of unpleasant hormonal side effects–feeling pregnant times about a hundred. Complications such as blood clots can develop. But the numbers for complications aren’t that high and the more we do the procedure the more we learn about controlling the side effects. Someone I know recently went through the process and her fertility doctor had her on this low-inflammation diet,which she said it really helped her a lot. That was interesting. The process and procedure itself – is pretty low risk but there is always some risk involved.
Is it painful?
You’re asleep because it’s uncomfortable.
Are different labs are better than others?
The more procedures a doctor does, the better they are going to be. There are people who are well known and in places that you wouldn’t expect. It’s also lab dependent. You want the best lab. Chances are the best -funded lab or the lab affiliated with the best hospital is going to have the best results.
How do you know that the lab that you’re working with is credible?
The embryologist and the technical capacity of the lab are the most important quotients. How up to date is the lab on their freezing methods? Patients can go on the ASRM (American Society for Reproductive Medicine) website and look at published data. You really have to look at published rates of success, from credible sources. Ask lots of questions i.e: How many live births have resulted from their clinic? What was the average age of those clients? Do they have an age limit for patients?
Is the cost coming down?
I ‘m not certain but it probably already has and it probably will continue. This field of medicine is a little bit like the Wild West. There’s plenty of science but people are paying cash and financing through the doctor’s offices and turning the practice of freezing eggs into a profitable business.
How do you talk to your daughters about this in a respectful way?
In my view, the only approach is: “this is going to piss you off and feel like a boundary violation” and then be ready for whatever the answer is. That could be anything from “fuck off” to “oh wow, will you pay for it?” And there are a lot of daughters who are going to be annoyed and pissed off but they’re pissed off and annoyed at us half the time anyway. As parents we often do something that we know is going to be unpleasant short term for us, but good for our kids in the long run. That’s parenting! If they’re pissed off then they’ll get over it. And if they don’t, there’s probably a bigger problem. And just because your daughter is an adult does not mean you stop being her parent.
Learn more about Dr. Gilberg-Lenz here
