With the advent of assisted reproductive technologies (ART), many women are taking advantage of freezing their eggs as a way to take control of their fertility. Some women fear they’re running out of time to find a spouse and seek to preserve their younger eggs while they can, and others wish to delay motherhood and instead focus on their careers. Still others want to preserve their fertility while undergoing medical procedures that may harm their ovaries, such as certain cancer treatments. And, since more companies than ever are now offering egg freezing in their benefits packages, more women are asking themselves: “Why not utilize this opportunity to take charge of my fertility?”
Using egg freezing as a “fertility insurance policy”
Dancing with the Stars dancer and judge Julianne Hough is an example of someone who chose to freeze her eggs as an “insurance policy” against future potential struggles to conceive. Hough recently shared that her decision to freeze her eggs was due to health issues that include endometriosis, her recent divorce, and the desire to “[free] herself from the ‘psychological fear’ of a ticking biological clock.”
Hough also stated that “I think the healthier I am from the inside out—as far as my beliefs, my energy, what I’m putting into my body—the better prepared [for motherhood] I’ll be when the time comes.”
But is egg freezing really the seamless, “fix-all” solution to indefinitely extending fertility? Can it really contribute to a woman’s health and well-being, as implied by Hough? Let’s take a look at some important considerations for those interested in freezing their eggs, no matter their reasons for doing so.
The high cost of (elective) egg freezing
For now, egg freezing for reasons other than infertility is considered an elective procedure. Because of this, insurance policies within U.S. states where egg freezing coverage is mandated will often only cover it for those undergoing medical treatments that may impact future fertility. While individual, specialized insurance companies like Progyny and WINFertility may cover elective egg freezing (or egg freezing for “social” reasons), companies that are often provided by employers, such Blue Cross Blue Shield and Aetna, have elective egg freezing coverage that varies by state and plan. Other companies like Cigna only cover egg freezing for medical reasons, which leaves many women paying out of pocket for the pricey procedure.
Egg freezing costs approximately $10,000 to $45,000 per cycle, or, to break it down further, the average cost of a cycle, including medication and egg retrieval, is around $5,000 and $11,000, respectively. The cost for egg storage varies from $500 to $1,000 per year, depending on the state. It’s recommended that women have 10–12 mature eggs extracted to have at least one embryo that’s considered viable to fertilize and transfer, depending on the age of the patient, number of eggs retrieved, the quality of the eggs, and how many children the woman envisions having. (Actual retrieval numbers vary widely by age, with one clinic estimating around 16 eggs per cycle for women under 35, and between 7-13 eggs per cycle for women ages 35-42.) Women can therefore end up paying an average of $32,000 or more for multiple cycles to achieve the recommended number of eggs, not including medications and storage costs.
Egg freezing costs approximately $10,000 to $45,000 per cycle, or, to break it down further, the average cost of a cycle, including medication and egg retrieval, is around $5,000 and $11,000, respectively.
In Vitro Fertilization (IVF), the procedure women must use to achieve pregnancy with their previously frozen eggs, also comes with a base fee of approximately $12,000 – $18,000, minus the already paid costs of egg retrieval. Not included in this base fee are the costs of any other required medications, thawing fees, preimplantation genetic screenings (to determine and transfer the “most viable” embryos), and other IVF-associated costs. Insurance coverage varies for these costs as well by state and provider.
Risks and side effects of hyperstimulating the ovaries and egg retrieval
Women seeking to have their eggs extracted must submit to hyperstimulation of their ovaries. This is done by the daily injection of follicle-stimulating hormones called gonadotropins, which stimulate the ovaries and suppress the natural ovulation cycle. These medications come with side effects such as headaches, breast tenderness, abdominal pain, bloating, and nausea, but the biggest risk they carry with them is the risk of ovarian hyperstimulation syndrome, since the body isn’t naturally made to release the amount of eggs required for retrieval.
[Ovarian stimulation] medications come with side effects such as headaches, breast tenderness, abdominal pain, bloating, and nausea, but the biggest risk they carry with them is the risk of ovarian hyperstimulation syndrome, since the body isn’t naturally made to release the amount of eggs required for retrieval.
Ovarian hyperstimulation syndrome (OHSS) can result in pulmonary issues, blood clots, stroke, kidney damage, and even death. OHSS also results in enlarged ovaries and an accumulation of fluid in the abdomen after stimulation and ovulation occur. According to the American Society for Reproductive Medicine (ASRM), a mild form of hyperstimulation syndrome occurs in 10% to 20% of cycles.
The egg retrieval process likewise comes with risk of injury to the bladder uterus, ovaries, and blood vessels. There is also the risk of infections, ovarian torsion and ovarian loss, and internal bleeding. The long-term risks of egg retrieval are not yet well-documented, which makes it difficult for those seeking to freeze their eggs to make fully informed decisions.
How egg harvesting may harm natural fertility
Again, the long-term risks of egg retrieval (perhaps more accurately termed egg “harvesting,”) are not yet well-documented, however, since there is a known risk of infection and bleeding during the process, we can infer that it may pose a risk of harm to a woman’s future fertility. For example, infection and the surgery required to treat bleeding both can lead to abdominal adhesions, which are a common cause of infertility [1] [2]. Furthermore, the puncturing of the ovary with a needle (which is required to retrieve mature eggs) can cause trauma to the ovary and lead to the formation of anti-ovary antibodies. Studies have found that anti-ovary antibodies can impact fertility by potentially affecting egg and embryo development, and contribute to implantation failure [3] [4].
If a woman decides not to use her frozen eggs and instead get pregnant naturally—and then finds it difficult to do so—it’s possible that the egg retrieval process itself may have actually inhibited her fertility. Given that many women freeze their eggs in an effort to preserve their future fertility, this could be an especially jarring side effect of the procedure.
How often does egg freezing result in a live birth? Let’s do the math.
In order to be utilized for the IVF process, an egg must first survive the thawing process. While it’s difficult to find exact numbers on the live birth rates when using frozen eggs (the CDC, for example, bundles together frozen eggs and frozen embryos), many fertility clinics assure women that frozen eggs “work just as well” as fresh ones. In one small study of fifteen women under age 38 and twelve women above age 38 (both groups of whom had frozen their eggs for “social” reasons—not medical) the thaw survival rates for their eggs were 119 out of 176 for the younger group (67.6%), and 138 out of 170 for the older group (81.2%) [5]. For the younger group, there was a 38% (6 out of 16) live birth rate per embryo transfer, and a 29% (2 out of 7) live birth rate in the older group.
Remember that IVF facilitators prefer having about 10 to 12 mature eggs available with which to work, and they expect about 80% of eggs to successfully fertilize. So, assuming a woman has 10 successfully extracted and frozen eggs, we might expect 7 or 8 to survive the thawing process, then between 5 or 6 of them to successfully fertilize (i.e., become embryos). However, only somewhere between 30% to 50% of these embryos can be expected to reach the stage where they have a chance to successfully implant within a woman’s uterus (i.e., reach “transfer stage”), or be placed into cryopreservation (become frozen for later use).
According to the Society for Assisted Reproductive Technology’s 2023 summary report, which includes data from both fresh and frozen embryos, the number of live, singleton births after the first attempt to transfer embryos was 41.5% for women under 35, 29.7% for women ages 35-37, 18.7 % for ages 38-40, and 2.8% and downwards from age 42 and on. For reference, the average age of the American woman seeking IVF is 36.3 years old, which means that the average American woman who freezes her eggs might reasonably expect to achieve about one live birth from undergoing the procedure (and subsequent IVF cycles).
For reference, the average age of the American woman seeking IVF is 36.3 years old, which means that the average American woman who freezes her eggs might reasonably expect to achieve about one live birth from undergoing a single egg-freezing procedure, followed by one to three subsequent IVF cycles.
Emotional impacts of egg freezing
In addition to the physical risks of egg freezing, the process can also take a heavy emotional toll on women. Due to the hormonal fluctuations caused by medications used to stimulate ovarian production, women can also experience mood swings such as depression, anxiety, and irritability.
A study that consisted of 108 women aged 25-44 who had undergone elective egg freezing found that “13% of women reported inadequate information; 13% inadequate emotional support. 36% reported feeling lonelier during the process, and 16% felt more hopeless about future family building. 36% agreed their experience ‘would have been improved by a chance to meet with a mental health professional’” [7]. It has also been noted that relatively few women who opt to freeze their eggs end up using them to create embryos, for a variety of reasons.
What steps can be taken to preserve fertility?
While egg freezing may be enticing as an insurance policy for fertility, there’s no guarantee of success, and some women intending to delay pregnancy with a contract vowing to protect them against their naturally waning fertility may actually find themselves unable to have children.
Most women would be better served by learning to monitor their natural fertility with a fertility awareness method (FAM), and by making any needed changes (or seeking any needed treatments) to improve their long-term, whole body health, as early in life as possible. And for those looking to avoid pregnancy in a way that won’t prematurely age their ovaries (as hormonal birth control has been demonstrated to do), FAM and/or NFP are likewise the smartest choice. Dietary and lifestyle changes can also help preserve egg quality, and, for those undergoing cancer treatments, ovarian tissue freezing is a novel option that may help some women preserve their fertility without resorting to egg extraction and freezing [8]. In a forthcoming article, we will explore these options in more depth.
