In 2012, the American Society of Reproductive Medicine came out with guidelines suggesting that egg-freezing technology should no longer be considered experimental. Since that time, whether egg freezing should be a routine part of well woman’s health care has been debated.
Clarisa R. Gracia, MD, speaking for the pro side during Saturday’s Edith Louise Potter Memorial Lecture “Should Egg Freezing Be Routine?,” and Anne Z. Steiner, MD, speaking for the con side, agreed that counseling patients about egg freezing should be routine but disagreed on whether the practice itself should be a routine part of a woman’s care.
“We know from several population-based studies that fertility declines over a woman’s life, particularly after the age of 30, and even more after 35 and 40, it becomes difficult for women to achieve pregnancy. Over the age of 45, it is very rare that a woman achieves pregnancy on her own. This decrease in fertility can be attributed to increasing aneuploidy in oocytes,” said Dr. Gracia, associate professor of obstetrics and gynecology and director of fertility preservation at the Hospital of the University of Pennsylvania.
For women wanting to delay pregnancy to pursue career ambitions or to wait for a partner, she said, egg freezing allows them to preserve their fertility in a safe manner with reasonable success rates.
A number of studies have shown that success rates are not significantly different from pregnancies attempted from vitrified eggs versus fresh eggs. Also, new treatment protocols mean health risks previously associated with ovarian stimulation such as hyperstimulation, ovarian torsion, infections and bleeding can be largely avoided.
“Today we have protocols using lupron triggers and other strategies that can essentially eliminate the risk of an ovarian hyperstimulation syndrome quite effectively. It’s much rarer today than it was five to 10 years ago,” she said.
On the other side of the argument, Dr. Steiner pointed out that most of the available studies involved donor eggs from much younger women, and not those of women in their late 30s or early 40s freezing their eggs for their own use. She referenced a study that indicated that the older a woman was when she harvested eggs for freezing, the more eggs she’d need to produce a potential pregnancy. For example, a woman age 38-40 would need 26 eggs for a 70 percent chance of a live birth, a number that would likely require three to four retrieval cycles, compared with a woman 30 to 34 who would need 13 eggs and just one retrieval cycle.
“Just when you need more eggs, you are going to produce even less,” said Dr. Steiner, a fertility specialist and associate professor at the University of North Carolina, noting that how many eggs and how many mature eggs are produced following ovarian stimulations declines with age.
The cost of egg freezing is also significant, she said. Each egg retrieval cycle averages $9,000, plus another $3,000 for medications. Add the cost of storage for any number of years and the cost of thawing, ICSI and transfer, and the expense can top out at more than $20,000.
And, there’s what Dr. Steiner called the “squishy stuff we need to consider,” such as the questions as to whether we are preying on the fears of a vulnerable population, creating a medical solution to a social problem, or whether we are creating a false sense of security.
“And we can’t ignore the potentially lucrative nature behind egg freezing. Clinics are popping up across the country, and people are making a lot of money off of this,” she said.
Potter Lecture Streaming Colloquia Video