You might have heard that Apple and Facebook will both soon cover expenses for female employees to freeze their eggs.
The truth is a bit more complicated (and awesome): Facebook and Apple will offer employees up to $20,000 over the course of their employment for reproduction-related services. That includes egg-freezing, yes, but also in vitro fertilization, surrogacy, and more.
Let's talk freezing your eggs for a minute.
People are talking about it like it's the most amazing invention of all time. That's partially because it really IS an incredible advancement in modern medicine. And it really can help women with fertility problems have babies. Now, undergoing chemotherapy for cancer or being diagnosed with endometriosis doesn't have to mean infertility. That's fantastic.
But egg-freezing as a safety net option for otherwise healthy women to delay pregnancy is a little more complicated. On the one hand, the more control women have over their reproductive choices, the better. On the other hand, freezing your eggs isn't necessarily a fail-safe way to control that choice, and some doctors are concerned about the way it's being marketed.
And maybe it is the right choice for you. But before you make that choice, you should know a few things.
1. It's still considered an "experimental" treatment.
The big endorsement of egg freezing came in 2012 when the American Society of Reproductive Medicine (ASRM) announced that egg freezing should no longer be considered experimental for women who use it due to fertility concerns — for instance, for women about to undergo fertility-threatening chemotherapy for cancer, or for those who suffer from endometriosis. But in that same report, the ASRM said that it should still be considered experimental for otherwise healthy women who were using it electively.
2. Because there hasn't been enough research to prove that it works, so doctors don't want to recommend it for otherwise healthy women.
Yes, it can work and is working for more and more women, so there's a growing body of anecdotal evidence to support the practice. But when it comes to clinical controlled trials resulting in peer-reviewed, published research on efficacy, safety, or pregnancy rates of egg-freezing to delay motherhood and extend fertility...not enough.
That's why a statement released last year by the American College of Obstetricians and Gynecologists (ACOG) reinforced the ASRM warning that there's just not enough evidence that it works as an elective procedure, at least for now. Doctors just don't have enough data on safety, efficacy, cost-effectiveness, and potential emotional risks to say "go for it!"
3. Some doctors are concerned that egg-freezing can give women false hope.
"I think these societies [ACOG and ASRM] are concerned that this approach can be exploited in patients where it's not appropriate, or could give false hope," Kutluk Oktay, M.D., a professor of obstetrics and gynecology and director of the Divison of Reproductive Medicine at the Institute for Fertility Preservation, told BuzzFeed. "It's not like putting money in the bank and accruing interest over 10 years. It might be that you think the eggs you had frozen were good, and then 10 years later you try to use them and it turns out they weren't."
4. And that fertility clinics (and maybe giant social media/technology companies?) shouldn't market the technology to women as a miracle cure for delaying pregnancy.
That doesn't mean you definitely shouldn't do it. It just means patients who do choose it need to be fully educated about the risks and the unknowns.
From that ACOG statement: "It is recommended that patients be thoroughly counseled about the current lack of data on efficacy, as well as the risks, costs, and alternatives to elective oocyte cryopreservation." See?
5. The government doesn’t require fertility clinics to reveal data about egg-freezing success rates.
We know a ton about in vitro fertilization because clinics across the United States are required by law to report all data about any IVF cycle to the Centers for Disease Control. But no such regulation exists for egg-freezing, according to an article published in Nature. This means there's no solid data on how many women in the United States have undergone the procedure, how many women have actually come back later to use the eggs, and how many have actually gotten pregnant down the line from eggs frozen early.
6. It’s a pretty intense process.
How to freeze your eggs, in five steps:
1. TESTING: Before undergoing the egg-freezing process, most clinics will put patients through a number of tests, Dr. Oktay says. These can include a medical history, a physical exam, STD screenings, and a blood test to see if you have high, average, or low number of eggs available for extraction. "If the woman has low eggs, we would talk to her about whether this is still a good option for her – it might not be worth it if it isn't likely to produce many eggs."
2. DAILY HORMONE INJECTIONS: You will inject yourself with hormones every day for two weeks. During the first week you inject yourself with a hormone that makes your ovaries go into overdrive, producing multiple eggs. (Typically your ovaries produce and release one egg per cycle.) During the second week you add a second daily shot to the mix. This one is to prevent you from ovulating.
3. TRANS-VAGINAL ULTRASOUNDS AND BLOOD WORK: Over the course of the two weeks, you'll go to the doctor about four or five times. The doctor will do blood work and perform trans-vaginal ultrasounds, to monitor you to make sure the eggs are developing appropriately and that you're not developing any complications (more on that later).
4. TRANS-VAGINAL EGG EXTRACTION: After the eggs are ready for extraction, you'll be given a sedative, and your doctor will insert a needle into your ovaries, through your vaginal wall, to extract the eggs one at a time.
5. FREEZING: The most successful form of freezing is called vitrification, and it's a flash-freezing technique that instantly cools the eggs to sub-zero temps for storage.
7. Side effects to the hormone injections can be rough.
Your doctor should be monitoring you during your two weeks of hormone injections very closely. Ten percent of patients respond negatively to the hormonal drugs, resulting in a dangerous condition called ovarian hyperstimulation syndrome (OHSS). OHSS causes your ovaries to swell, occasionally to dangerous levels. Symptoms can range from mild to moderate to severe, and can include bloating, nausea, diarrhea, severe abdominal pain, trouble urinating, and rapid heartbeat. In (very rare) cases, it can also be fatal.
8. Freezing your eggs is incredibly expensive.
For all the women who don't work for Apple or Facebook, the procedure isn't covered by insurance (in part because experts still classify it as "experimental") so it can cost around $10,000, plus at least $500 a year for storage. And that's not even counting the cost of the drugs and tests associated with it, OR the process of IVF to use those frozen eggs down the line. Jezebel did a pretty thorough breakdown of potential expenses.
9. The younger you are when you freeze your eggs, the better your odds.
"The problem is that most women wait until their late thirties until attempting this, which reduces success rate," says Dr. Oktay. The best age to freeze your eggs is in your twenties or early thirties, before the quality of your eggs begins to decline, he says.
10. Most women aren't freezing their eggs for their careers.
People were critical of Apple's and Facebook's decision to pay for egg-freezing, in part, because the announcement came across as seriously cynical: Companies paying their employees not to get pregnant, so they could focus more on their careers...at those companies.
But the companies actually offer a whole range of family-friendly benefits tied to reproduction and fertility choices, not just egg-freezing (more on that, here). And beyond that, most women aren't freezing their eggs for their careers, anyway.
For a 2013 article published in the journal Fertility and Sterility, one fertility clinic surveyed over 100 patients who had undergone an elective egg-freezing procedure. Fifty-nine percent said they were freezing their eggs as a backup plan, in case natural pregnancy became impossible down the line. Thirty-nine percent said it was both a backup plan and a way to defer childbearing.
Also worth mentioning: Eighty-eight percent of the women said the reason they hadn't had babies yet was because they hadn't found the right partner. And 19% said they were child-free because their workplaces weren't flexible enough.