Why more women are freezing their eggs and delaying motherhood
CAREERS, LACK OF STABLE PARTNERS CONTRIBUTING TO TREND
From “egg showers” to viral Tiktok videos of 20-somethings sharing their egg-freezing journeys, oocyte cryopreservation is having its big moment. The number of women in Canada seeking to preserve their eggs for non-medical purposes is on the uptick, with 1,200 egg-freezing cycles reported in 2021, compared to a mere 94 in 2013.
The numbers doubled between 2020 and 2021 alone, an unexpected pandemic surge. With social and dating lives upended, “a lot of people feel they lost three years of their reproductive life,” said Dr. Sony Sierra, president of the Canadian Fertility and Andrology Society.
In Canada, the average age for first-time mothers is 31.4.
“Society is sort of telling us, dictating, especially to women, what they should do — get your education, travel, get a job, buy your house, meet a partner, and follow that path. But of course, our reproductive anatomy hasn't caught up,” said Carolynn Dubé, executive director of the patient group Fertility Matters Canada.
Egg freezing can alleviate pressure, Dubé added, “that sort of societal pressure, even the pressure a woman feels for herself on her future family-building plans. This is something they can do in their early to mid20s, even their early 30s.”
Apple and Facebook were among the first to pick up the costs of egg freezing for female staff, and other major tech companies and big banks followed suit, though corporate Canada has been less enthusiastic than corporate America to embrace employer-paid egg preservation. Still, Canadian fertility clinics are hosting virtual webinars for the curious on “all things egg freezing,” heartening fertility specialists and patient advocates who say it's important to make young women, or young people with ovaries, aware of age-related changes to the quantity and quality of their eggs.
While it's often pitched as a fertility insurance policy or backup plan for when women are ready to conceive, egg freezing is expensive. There's no guarantee of a pregnancy or live birth in the end and, rather than bolstering a woman's reproductive freedom, a recent study found egg-freezing workplace perks can seem more pressuring than progressive, an implicit nudge that women should make work, and not babies, their central focus.
Others argue the primary reason women are electing to place their eggs in deep freeze is a lack of worthy and stable reproductive partners.
What to consider when considering egg freezing? Below, the National Post's Sharon Kirkey explores the egg-freezing business and debate.
WHAT IS IT, AND DOES IT WORK?
“In a nutshell, freezing your eggs prevents them from aging as they normally would,” according to Toronto's EVOLVE, the first clinic in Canada fully devoted to egg freezing, and where Sierra serves as medical director.
Females are born with about one to two million immature egg cells, or oocytes. Their egg reserve decreases with age. By age 37, a woman has 25,000 oocytes left; by 51, the average age of menopause, about 1,000, according to the American College of Obstetrics and Gynecologists.
If a woman freezes her eggs at a younger age, she may have a higher chance of pregnancy, and lower chance of miscarriage, when she's ready to use them.
As part of the process, a woman injects herself daily, for two weeks, in the belly or upper thighs with hormonal drugs to stimulate her ovaries to produce around 10 to 15 mature eggs, instead of the usual one egg per month. The more eggs to freeze, the more likely one of those eggs, once thawed, will be fertilized with sperm, develop into an embryo and lead to a pregnancy.
Once the optimal size and number of eggs has been generated, the eggs are retrieved from the ovaries via an ultrasound-guided needle, flash-frozen into a glasslike solid state within seconds, and stored in tanks of liquid nitrogen.
Fertility doctors say the optimal time to freeze eggs is in the 20s or early 30s, when a woman's ovarian reserves are high. Age at “cryopreservation,” and the number of eggs frozen matters because they both affect success rates.
“If someone is freezing their eggs at age 30 or younger, and we have 20 eggs, then we can guesstimate that in the future there's probably about a 55 per cent chance of a pregnancy there,” Sierra said. Her clinic uses an AI program that looks at eggs under high-powered microscopy to predict the chances an egg has at becoming an embryo.
One U.S. study based on 15 years of real-life “frozen-egg outcomes” at a New York University-affiliated fertility clinic found that overall, 39 per cent of women had at least one child from their frozen eggs. It was 51 per cent if the woman was younger than 38 when she froze her eggs, and 70 per cent cent if that under-38 woman thawed at least 20 eggs.
The length of time in the cold storage doesn't affect birthrates. Neither does the age of the woman at the time an embryo created with a thawed egg is transferred to her womb. The uterus is an amazing incubator. “We can manipulate the uterus to be able to accept an embryo at any age, really,” Sierra said. It varies clinic-to-clinic, there's no national policy, but at Trio fertility clinics in Canada, where Sierra is also a deputy medical director and partner, “we don't transfer embryos over age 49.” Others will do so up to age 55.
Potential risks from egg freezing can include bleeding, infection and internal injury, according to a Mount Sinai Fertility video. Ovarian hyperstimulation syndrome, when a woman's ovaries swell and leak fluid into the body, is also a risk of fertility treatments, though the published risk is about one in 200, Sierra said.
Egg freezing doesn't involve the addition of a drug that normally triggers hyperstimulation.
“It still happens, and it can still be an uncomfortable procedure if people do respond briskly to the medications and have very enlarged ovaries and lots and lots of follicles.”
One in 10 women on hormones will experience hot flashes, mood changes and some abdominal discomfort. There doesn't appear to be an increased risk of breast or ovarian cancer that doctors know of, Sierra said.
It can take more than one egg-freezing cycle to produce the optimal number of eggs, at a cost of up to $10,000 per cycle. Medication costs (another $6,000 to $8,000) may or may not be covered by private insurers.
There's also an annual storage fee (typically $300) and, later, the cost of in vitro fertilization. It's only available to women of a higher socioeconomic class.
WHY ARE WOMEN FREEZING THEIR EGGS?
The Kardashians (Kim, Kourtney and Khloé) and other celebrities have opened up about freezing their eggs. Khloé Kardashian got “round” while she was on “all those hormones freezing my eggs.” Kourtney, 41, and mother to three, froze her eggs when she was 39 as a backup in case she might want to have another baby.
Today, postponing pregnancy is the new norm.
Not every woman who freezes her eggs will need to use them. They may meet a partner, get pregnant and off they go, Dubé said. Studies suggests only one in 10 women, and as few as six per cent, return to warm and fertilize their eggs. However, infertility rates are rising and, should women end up needing fertility care, “they've got these young eggs” in reserve, Dubé said.
And egg-freezing has only taken off in the last six to eight years. “So, we're early days of people coming back in big numbers to utilize their frozen eggs,” Sierra said.
Even when they are in a relationship, partner problems, more so than career planning, lead most women to freeze their eggs, according to a study based on interviews with 150 American and Israeli women who underwent at least one egg-freezing cycle. Women said their relationship was “too new or uncertain,” their partner wasn't ready to have children, their partner was refusing to have kids, or their partner had his own multiple partners.
Some young women come in because they have a family history of early menopause or advanced ovarian aging, Sierra said.
IS IT ABOUT FREEDOM?
“At EVOLVE, we want you to live your life to the fullest — on your schedule,” according to the clinic's website.
Egg freezing can allow women to delay having a family until later, just as some men do. The technology, which, as of 2012, is no longer considered experimental, has been called the greatest advance in reproductive medicine since the development of The Pill — oral contraceptives.
However, in addition to concerns around potential risks, and whether women are getting sufficient information to make truly informed decisions, Vanessa Gruben, a professor in the department of law at the University of Ottawa, has argued that women may feel pressured to freeze their eggs, “especially where this is a `benefit' paid for by the employer.”
“First and foremost, it really fails to address some of these bigger systemic questions we have about caregiving issues in the workplace, and whether we should be thinking about creating policies that accommodate caregiving as opposed to just delaying fertility,” Gruben said in an interview with the National Post.
There's also this gendered assumption that women should become mothers, she said. “And so, if you're being responsible, and you're going to be a mother, you need to freeze those eggs now, because who knows what's going to happen,” Gruben said.
Why not more flexible policies for parental leave, she said, or daycare in the workplace?
And while the age of the uterus might not matter, pregnancy-related complications such as gestational diabetes and high blood pressure increase with age.
The way Dubé sees it, reproductive health options are being taken away from people in many parts of the world.
“In certain provinces or territories, you can't even see a fertility specialist, because they don't exist. So, freezing your eggs and flying to a city that does it isn't attainable,” Dubé said.
“Not everyone is going to choose to do this. But, certainly, for younger people who have chosen to do this, they have felt it to be a great option for them.”