Get Eggs Froze

A few years back I endorsed an unfairly-neglected tech to extend life: cryonics.  Yesterday, Amara Graps reminded me of a related unfairly-neglected fertility-promoting tech: egg freezing. Slate in March:

In 2004, the fertility field’s professional organization, the American Society for Reproductive Medicine (ASRM), declared egg freezing “experimental.” … In an unprecedented paper calling for the removal of the experimental label, three of the world’s most prominent researchers in egg freezing claim the technology has vastly improved and is safe: Frozen-egg babies, so far, have no more health problems than the rest of the population. Doctors who support the experimental classification argue that more research is needed and say they’re still uneasy offering the technology to vulnerable women who might unwisely be counting on their frozen eggs years after extraction. … Egg freezing … has been unfairly singled out. By comparison, the adoption processes of other breakthroughs in fertility medicine, such as freezing embryos, injecting sperm into eggs to help men with low sperm count, or screening embryos for abnormalities, have been more informal. … The ASRM did not assign them the term ‘experimental.’ “

In fact, egg freezing received such an outsized institutional smackdown that the ASRM pointedly said it “should not be marketed or offered as a means to defer reproductive aging.” Why the special treatment? Many members … feared women would use egg freezing as “baby insurance” by paying $8,000 to $13,000 per cycle to stash away some good eggs in case their fertility is gone by the time they’re ready to become mothers. …

Many IVF programs are achieving the same success rates using frozen eggs as they normally would with fresh eggs. … Other practitioners have less stellar results. Many have no data at all because they’ve never thawed the eggs they’ve frozen. Although 54 percent of American clinics now offer the procedure, only 1,500 babies have been created from frozen eggs in the world. … With more competition, professional standards would rise and the price might even go down.

Seems docs discourage freezing eggs because they fear people might find, horrors, that it works and adds value. Gee we wouldn’t want people using something that might save the world from a falling fertility collapse!  Sigh. Yes, let’s encourage this, and get usage up and costs down.

Let’s not forget at a big cause of falling fertility is women thinking they can wait longer than they can to have kids. Here’s Bryan citing a 2001 survey:

In the survey, “high-achieving women” are basically those in the top 10% of the distribution of female income. … Survey highlights:

  • 33% of high-achievers … are childless at age 40.
  • “Looking back to their early twenties… only 14 percent said they definitely had not wanted children. … More than a quarter … in the 41-55-year-old age bracket said they would still like to have children”
  • Only 1% … had a first child after 39.
  • 89% of young high-achieving women believe they can get pregnant into their 40s. In reality, only 3-5% of women in their early 40s are able to have a live birth using in vitro fertilization.

For more quotes, here is Nature in 2007:

Freezing a woman’s eggs for use later in fertility treatments doesn’t seem to greatly increase birth defects or abnormalities, new data suggest. … The field remains caught between researchers, most of whom say that the practice should still be considered experimental, and the public, which is itching to embrace the technology to extend a woman’s fertile years. .. most researchers think that the procedure is not appropriate for women who wish to delay fertility for social, career or other non-health-related reasons. … “there remain very few studies in which the safety and efficacy of this practice can be judged.” …

An ASRM [American Society for Reproductive Medicine] committee … recommended that egg freezing continue to be considered experimental, and not be marketed or promoted to healthy young women. … Egg freezing, which has been in place for at least two decades, has not been used widely; doctors estimate that between 300 and 600 children have been born from formerly frozen eggs. …
Safety remains one of the main concerns. …

[Researchers] presented an analysis of more than 37 publications on children born from cryopreserved eggs. Of 555 live births … he turned up just 3 other major abnormalities. … Five abnormalities in 550 births is a less than 1% abnormality rate — comparable to that for a natural pregnancy. The study didn’t address efficacy, though. “We don’t know the denominator — we don’t know how many [pregnancies] were terminated.” … A small study in which 28 slow-frozen eggs, and 35 vitrified ones, were thawed then fertilized. Further analysis of the results indicates that for every 21 oocytes frozen via vitrification, one pregnancy could be expected. The numbers were slightly worse for slow-rate freezing: 45 frozen eggs per pregnancy.

Here is Amara in 2009:

An unborn human baby girl has already produced all of the … unmature egg cells, that she will produce in her lifetime. … About 400, will mature into eggs to be viable for reproduction in her entire lifetime. … A dormant egg cannot perform the usual cellular repair processes, however, so damage increases as a woman ages. … Egg freezing is a viable technology since 2002, however the societal progress for acceptance is extremely slow. Even though the egg extraction portion of egg freezing has been in practice in IVF for decades, egg freezing is considered by the American Society for Reproductive Medicine, as late as late-2007, to still be an experimental procedure, despite the fact that vitrification, the process in which water is drawn out and anti-freeze chemicals added, is improving success rates to the same level as normal IVF treatment. Many doctors will freeze eggs for cancer patients, but will not offer the option to young, fertile women. Their perspective is that it is unethical to normalize a woman’s waiting to bear children. … Costs for a young woman undergoing such a procedure is also prohibitive (USD ~10 000) at that early point in her career life.

However, out of the three reproductive technologies listed here, egg freezing technology provides the most courageous and comprehensive assistance to women and has the potential to change society the most. …  With this technology, the woman has twenty more years of buffer time in which she can build her career to something supportive for herself plus her family. … Single women who find themselves mateless during their usual prime years, will now have time to build a better life to support themselves and their children. …

Extend Fertility (http://www.extendfertility.com) recruits women interested in egg freezing and connects them to a network of cooperating egg freezing clinics. … As of late 2006, 2000 women had inquired, and of those, 200 had frozen their eggs.

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  • Carl Shulman

    Having kids later is much less effective at increasing population quickly. Even if widespread adoption of egg storage increases the number of children a typical woman has over her life, it could easily slow population growth by further encouraging delayed childbirth. And even the net effect on children per woman over time might be negative depending on how women change their plans.

  • http://www.amara.com/ Amara null Graps

    Thanks, Robin, for following up on my comment yesterday!

  • Michael Hunter

    The various moral arguments about not wanting change should be irrelevant. The individual should be provided the data and allowed to spend their own money in making their own decisions. Plenty of parents make horrible decisions wrt their health while pregnant and how they feed and raise their children. While it is easier for us to control point decisions like egg freezing that doesn’t make that control any more effective.

    OTOH this article seems inconsistent. Given the low rate of many birth defects “only 1,500 babies have been created from frozen eggs in the world” isn’t enough to turn into “Five abnormalities in 550 births is a less than 1% abnormality rate — comparable to that for a natural pregnancy” a statement about the procedures safety.

    I guess it is typical that in debates involving base humanity and especially mating/reproduction that people use science to support their preconceptions instead of using it to discover the truth.

  • jemand

    but you don’t really want to “increase population quickly.” You want a nice, stable population. Populations that are doubling extremely rapidly aren’t that great either, and have problems, just different ones, from populations where there is an eminent fertility collapse.

    And women are likely to change their plans in reaction to the environment– if it is changing such that the quality and quantity of life of potential offspring looks good and she has enough resources to have children, she’s likely to choose to have more than if not. And we WANT children born in situations most amenable to them growing up well, if we, again, want a stable, prosperous society.

    We don’t just want bodies, we want citizens who have had a lot invested in them, and as such, can have a lot to offer back to society. In THAT respect, it will be VERY good to give women longer to choose to have, or not have children, because they are able to change their plans with respect to the resources available over a longer period of time and we will end up with better *quality* citizens and not *just* more of them.

  • Buck Farmer

    Hear hear! Egg freezing and surrogate wombs (someday artificial wombs) will be great victories for women’s rights. Finally, they will have the same level of control over their reproduction as men.

    Naturally, we should be wary of coercing the world’s poor into bearing children for the world’s rich, but we should be concerned about coercion anyway and this should not be treated as a special case.

    Something is lost when you move beyond our ancestor’s pregnancies, and I don’t think we fully understand the mix of physical and emotional changes that occurs over the course of a standard pregnancy, but I think the trade-off is something that individual women should be allowed to choose. With time our culture and institutions will find ways of mitigating these losses and perhaps a great diversity of reproductive methods will flourish to the greater diversity (and survivability) of the human species.

  • http://entitledtoanopinion.wordpress.com TGGP

    “Costs for a young woman undergoing such a procedure is also prohibitive (USD ~10 000) at that early point in her career life.”
    How much of that could be offset by selling eggs, as Kerry Howley did?

    Amara, is your middle name really “null”?

  • http://www.amara.com Amara Graps

    TGGP,
    No, the null was inserted by my browser software when I wasn’t looking…!

    As to the $10K, I suggest that the young women travel out of the United States for the procedure. IVFs in Estonia are about 1/5 the cost of those in the US, for example (with little difference in quality), so I expect the egg freezing costs would scale similarly.

  • Lucy

    Good post. I am almost certainly going to freeze my eggs in the future, as are several of my friends. I am surprised that the option is apparently so little known. Luckily I’m in no hurry and will be able to observe the field over the next decade to see if the technology becomes safer, cheaper, or otherwise better.

    I don’t know if this will penetrate the general population as quickly as the birth control pill did, but it’ll be a godsend for a certain type of woman. Specifically, highly educated, talented women who currently are faced with the choice of how much of parenthood or their careers to sacrifice for the other. That’s bound to be good for the gene pool.

  • Abelard Lindsey

    Why do you need to increase fertility? There are already ongoing efforts to cure aging, to make radical life extension possible. This will solve all of the problem.

  • http://rocknerd.co.uk David Gerard

    The essential difference is, of course, that unlike cryonics this technology is controversial because it does work.

    • Luke

      Your definition of “work” is obviously suspect.

      • http://rocknerd.co.uk David Gerard

        There is presently no working cryonics technology. There is a working egg-freezing technology, and that it works is what is controversial about it.

        That both cryonics and egg-freezing involve cold is not a sufficient justification for declaring them comparable technologies. The cold is not controversial; it’s that the technology in the second case works that’s controversial.

        There are many technologies that don’t (as yet) work would be widely controversial if they worked. However, that doesn’t mean that a technology that is controversial precisely because it does work is an excuse to bring up one of the technologies that doesn’t work.

        It’s like reading K. Eric Drexler’s blog: the good stuff is not original and the original stuff is not good.

      • Luke

        There is presently no working cryonics technology.

        For a weasel definition of “working” you might say that.

      • http://www.hopeanon.typepad.com Hopefully Anonymous

        David Gerard nailed it.

      • Luke

        David Gerard nailed it.

        What, with his sweeping pronouncement that cryonics doesn’t work?

        I would think the real difference is that cryonics is uncertain to work.

      • http://rocknerd.co.uk David Gerard

        There is no cryonics technology with evidence of working.

        There is a prospect of it working, of course. Revival requires not only as-yet uninvented technology, but as-yet unrealised scientific breakthroughs, and the assumption that the scientific breakthroughs we would need will in fact work out the way we would need them to. This is a profoundly slim chance to pin one’s hopes on, but it does not provably violate physics as we currently know it.

        However, that it is not impossible that cryonics will work in the future is not in any way the same as it working now.

      • Luke

        > There is no cryonics technology with evidence of working.

        Excellent structural preservation of vitrified brain tissue slices.

  • http://www.amara.com Amara Graps

    Upon reading some of the comments following the Nature 2007 article,
    there is something odd about the comment by Mel Joules. She says: “Egg-freezing has been the standard of care in Italy since 2004!”

    I’m quite sure that assisted reproductive technology in Italy is forbidden to single women in that society (that is one of the reasons I left) including procedures such as freezing eggs, so either she wasn’t aware of the laws that changed in 2005 or else there exists only very special circumstances by which egg freezing is permitted.

    But one can travel elsewhere (and many Italian women too) to get the support that they are seeking. IVF is already a motivation for the medical tourism that exists in Europe and so my guess is that egg freezing will follow a similar pattern in Europe and elsewhere.

  • Curt Adams

    Egg-freezing is different from all the other techniques in that it does not treat infertility. The other techniques are used for couples have have already had trouble with unassisted reproduction. Egg-freezing is for delaying attempts at reproduction, which will produce a substantially worse outcome than trying right away (IVF does not have a great success rate). So while other techniques will improve fertility, egg-freezing might well decrease it and hence the reluctance of fertility doctors to approve it.

    • Douglas Knight

      That is an important observation, but I think I think it is not the effect on fertility that is important, but just the difference between “fixing a problem” and “augmentation” that drives medical opinion.

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  • http://www.amara.com/ Amara Graps

    Dear Curt:

    For egg freezing, there is the egg extraction part and the freezing part. The egg extraction part is identical to the procedure for IVF, whether the woman uses her own eggs or that of a donor’s.

    In my opinion, for egg freezing to appeal to young women, the medical community will not only need to reduce costs, but will need to offer a more comfortable alternative to the daily hormone injections.

    Presently she must carefully guide and prepare herself at each stage of her monthly cycle with hormones, first to suppress the follicles and egg production, then to stimulate them for surgical extraction. The hormone preparation requires daily injections, because the hormones don’t stay in the body more than 24 hours, up to the time of egg extraction, for between one and two months. It’s unavoidable to exit those phases without bruises. This info is not well-advertised for women undergoing IVF or egg freezing because it would probably scare many of them off! You can find, however, an abundance of YouTube videos of the injection procedures by the women themselves if you want to learn about it.

    IVF’s success rate for one cycle is between 10 and 20%. (Costs in the US for one cycle are between 20K and 30K).

  • http://TheEmpoweredEgg.com TheEmpoweredEgg

    Thanks for a great article, one which I believe to be fair and accurate. They say that there isn’t enough proof to substantiate the removal of the experimental label but the only way to improve those numbers is to offer egg freezing for social reasons.

  • Abelard Lindsey

    No. I don’t expect egg freezing to become popular. Both eggs and sperm can be manufactured from stem cells which, in turn, can now be manufactured and rejuvenated from regular somatic cells. This means that a cell can be harvested from your body, at any age, be converted into a stem cell, then rejuvenated (See: http://www.biotimeinc.com/overview3-10.htm). These rejuvenated cells can then be converted into both the sperm and the egg to make a baby. I think a microfluidics device can be developed that will automate this entire process and make it cheap.

    There is no cloning involved. There is also no harvesting of eggs from young women, which is a medically risky procedure.

    The only missing puzzle piece is the exowomb, which will be a long time in coming. Development of effective exowombs will be quite difficult involving considerable risk and liability. It is likely that exowombs will be developed in East Asia (China, Japan) for a variety of cultural and legal liability reasons.

    BTW, natural child birth, in and of itself, is a medically risky process, a fact that many men and even some women are not aware of. 40% of all childbirth involve medical complications and 15% of all childbirth result in long term medical complications for the birth mother. This is the reason why I believe exowomb technology will eventually be developed and will largely replace natural childbirth once it is proven safe and effective.

    • Lucy

      Do you have an estimate of how long it will take to develop an exowomb?

      • Finch

        The exowomb will likely fall out of better and better NICUs, rather than being developed by some rogue scientist in a basement. We’ll creep up to it with incremental improvements to the technology that deals with premature birth.

        Right now, 25 week old babies have a 50 percent survival rate in a modern NICU. That’s four months early, and a good bit of the way to an exowomb.

    • http://www.amara.com Amara Graps

      Abelard: Your childbirth statistics reference? It sounds to me like US hospital statistics, which give a skewed perspective. The numbers are in sharp contrast to other western countries. In addition, once intervention begins in a hospital (for example, inducing labor) there’s often a cascade of then more interventions because the normal muscular functioning of the uterus is broken. If you talk to the midwives they tell a different story. Unfortunately there are not as many hard numbers coming out of homebirths and birthing centers so what you hear are numbers like what you are quoting. The documentary: The Business of Being Born describes some of this.

      • Abelard Lindsey

        Yes, I’m using hospital statistics. Also, some of it is anecdotal. For example, women who get gestational diebetes, and how you see all of those TV ads for incontinence products, which is also due to child birth. The fact that there are TV ads for this stuff suggests to me that the problems are common and widespread.

        As for exowomb technology, I think this is going to take 50 years. The reason is that not all of the nutrients and hormones that are in the mothers blood (and pass on to the developing baby) have not be identified and this will take some time. Experimental procedure is also bioethically problematic, to say the least (even though I consider bioethicists scum with regards to radical life extension, they are spot on on this issue). There are going to be some horrific mistakes in the development of effective exowomb technology, such that even I (the wild-eye transhumanist) have ethical reservations about what its development will involve. The liability and bioethical issues make exowomb development essentially impossible in Western countries.

        It might even be problematic in Japan, South Korea, and Singapore. If it is developed, it will be done in either China or India.

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