In our last blog post we discussed the pros of fertility preservation. And there are many, as technology has finally caught up with women’s desire to have it all on their own terms and at their own pace. For many women, freezing their eggs when they are young can alleviate the anxiety and urgency related to everything from achieving education and career goals to finding the right match and settling down to start a family.
While all of this can be great, there are several pitfalls and considerations to keep in mind when making the decision to pursue fertility preservation:
1) Freezing eggs is expensive. The $5,000-$10,000 price tag is a hefty sum to come up with, particularly for a young person. And it requires more money and procedures later when it is time to thaw, fertilize, and implant the newly made embryos. Natural conception is certainly more cost effective.
2) Statistically speaking, pregnancy rates per egg are low. Human biology, after statistical analysis, suggests it takes about 100 eggs to make one baby. That means for each egg there is only a 1% chance of pregnancy. Will women go through five to ten stimulated cycles to ensure 100 eggs are grown, recovered, and frozen? While this is the pessimistic way to view these statistics, it is relatively realistic, too. (Alternatively, if an egg survives the freeze and the thaw and is successfully fertilized via Intra-Cytoplascmic Sperm Injection (ICSI), then there is a 30% chance of pregnancy after an embryo transfer. Pregnancy rates per month in the population are 20% per month at age 25 and drop to 5% per month at age 40. So a positive way to look at the statistics is to recognize that if frozen egg cycles have a 20% success in any one cycle of thawed eggs, then older women do have a better chance at pregnancy using eggs frozen when they were younger.)
3) Eggs don’t always survive freezing. Delaying childbearing definitely impacts the natural ability to conceive. And if a woman waits into her 40s, it may be too late to stimulate the ovaries and use the eggs still available — thus the frozen eggs end up as a failed insurance policy.
4) Eggs and embryos may not be the same after they are frozen. There is data that supports the idea that women who conceive using IVF experience a slightly different pregnancy. There are more preterm births and low birth weight babies. Initial studies also suggest a 1% increase in birth defects in eggs, sperm, and embryos that are cultured in a lab. Other evidence suggests that with IVF and ICSI there may be an increase in “epigenetic defects” (i.e. Angelman and Beckwith-Wiedemann Syndromes), as well as sex chromosome anomalies. Autsim rates may even rise with Assisted Reproductive Technologies (ART).
When only a small percent of the population uses ART for infertility, the numbers of babies affected by this small increase in defects is infinitesimal. But if half the female population avails themselves of technology to delay childbearing, this may affect a much larger percent of the next generation. And these may be unnecessary risks that women are taking—if they had conceived at a younger age, they would not have needed ART.
5) Egg freezing may come at a price to the next generation—and that is an unknown risk. It is important to consider that children born to older parents may find themselves entering early adulthood without their parents’ help, as mom and dad may be dealing with their own failing health due to aging. And more and more young children may be forced to deal with their parents aging and mortality.
6) Egg freezing may be the beginning of eugenics, which opens up a number of moral questions. The science of theoretically improving the human population by controlling breeding is evolving, and as we use technology to conceive and “order up a baby,” our perspectives on reproduction choices are also changing. As Christine Rosen so aptly put it in her recent Wall Street Journal editorial, “The Ethics of Egg Freezing, “A society in which young women routinely freeze their eggs could develop very different attitudes about children and the arc of a human life. The more control we have, the more we expect the end result — the child — to turn out the way we want it to, and the greater the disappointment when he does not.”
The bottom line is we are entering into a new world, and we don’t have all the answers. But there is enough early information that begs equal consideration from each angle: both the pros and the cons.
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