Monday, May 14, 2012

The frozen egg gamble

One of my girlfriends, on the almost eve of her fortieth birthday, asked me, "If you didn't have the Grape when you did, would you have frozen your eggs?"

I told her probably not. Mainly because the technology, often viewed and sometimes marketed as insurance, is actually a very expensive gamble.

Though many fertility clinics offer egg freezing (for a price tag in the $10,000 to $15,000 range per cycle, plus annual storage fees in the hundreds), and the technology has come a long way in recent years, eggs just don't seem to freeze as well as embryos.

Indeed, they're maddeningly fragile, compared to other kinds of cells.

According to today's NYT, about 2,000 live births to date have resulted from frozen eggs.

This is not a large number, when you consider the world population hovers north of six billion human beings. In fact, those odds are abysmal, though not stark enough to dissuade plenty of well-heeled retirees from footing the bills for their daughters, in the hopes of one day welcoming biological grandchildren.

Egg preservation: The new it gift for the 35th birthday? Perhaps. Though I wouldn't advise anyone to subject herself to injectable hormone therapy just to please her parents. If you're going to do this, do it for yourself, and be an informed consumer.

The HUGE question I would advise any girlfriend considering the procedure to research: how many of those 2,000 live births resulted from use of frozen donor eggs?

Because most egg donors are college girls. Not women pushing forty. Before I drop the kind of cash required for egg freezing, I'd want to know the real odds of eventual live birth from my own frozen, more mature, eggs. And I'd want to know how those odds would change as time passes.

I'd want to know how many hormone treatment cycles I should reasonably expect to endure to produce enough eggs to make the exercise worthwhile.

As anyone who's gone through IVF knows, every egg doesn't make it as an embryo, and only the best and strongest embryos ever see the inside of a uterus. It's like a pipeline that narrows at each phase: you might get 16 good eggs (for example), which might get you six embryos that might, if you're lucky, get you one child. A good reproductive endocrinologist won't sugar coat the numbers. If your doc strikes you as more cheerleader than scientist/clinician, please run the other way. S/he isn't the only game in town, and you want to feel good about your doctor. Assuming you eventually un-freeze your eggs and try to fertilize and implant them, you'll be back for one or more cycles of IVF.

Regular readers know I'm all about women having choices.

But I'm also suspicious of a new, booming business springing up to prey on women's fears concerning their biological clocks with largely unsubstantiated promises of "better technology."

If I decided to try to hedge my bets by freezing eggs, I might procure some donor sperm and make some of those eggs into embryos as a further hedge. Why not? Same hormone treatment. Not much additional cost. Embryos freeze better than unfertilized eggs.

So my advice to my girlfriend is ultimately the same as my earlier advice, when asked if I had ever, before R. and the Grape, considered single motherhood by choice:

Don't do what I think I would have done. Do what's right for you, but please do so with eyes wide open. Before you make a gamble, understand your odds.

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