Egg freezing is on the rise: ‘Fertility insurance’, or a risky lottery?

This story is part of the April 19 edition of Good Weekend.See all 13 stories.

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ere’s a thought experiment. It’s 2017, and you’re a 35-year-old Australian woman with your own successful business. You’re four years into a relationship with a man five years younger than you, and he’s just won a Fulbright scholarship to the US. You really love each other, but it’s safe to say you’re at a low point in your relationship. He wants you to go to America with him, but he won’t talk about the future – in particular, he doesn’t want to discuss having children with you. You’re not even sure you want a baby, but the whole situation is driving you crazy. What do you do?

If you’re Celia Zara*, you freeze your eggs. “I did it for my own sanity,” she says, sitting in a cafe in Sydney’s CBD, glamorously slim-limbed and smiley, with thickly curling dark hair. She’s wearing a stretchy dress, and she’s eight months pregnant. She gestures with her fork. “I felt like I became this psycho. And so I was like, ‘OK, I have enough money. I’m just going to freeze my eggs.’ ”

Egg freezing does what it says on the tin: it takes eggs from a woman’s body and freezes them, at minus 196 degrees, until she uses them to try to have a baby, donates or disposes of them. From a societal perspective, it works because there’s an increasing number of women who want the option of having their own biological children, but for various reasons – their career or education pathway, their relationship circumstances, their health – they’re worried they won’t get pregnant during their most fertile years. Scientifically, it works because an egg from a 30-year-old, fertilised and returned to her body when she turns 40, is still 30. And since the largest factor determining female fertility is egg age, a 30-year-old egg is significantly more likely to make a baby than one a decade older.

No wonder clinics who perform egg freezing call the procedure an empowering insurance policy against fertility decline. Freeze your eggs now and you can relax, they say: freeze your eggs and feel secure in the knowledge you’ve given yourself more time, more choice, and more freedom in the way you build your family.

But the statistics tell a different story. Late last year, a detailed international review of studies, including results from nearly 9000 women, revealed that only 11 per cent returned to use their eggs. Of these, only 28 per cent gave birth to a live baby.

Figures like these sit oddly in an industry that leans so heavily on words like “insurance”, “choice” and “options”. Professor Marcia Inhorn is a medical anthropologist at Yale University. “This language of ‘fertility insurance’ has been used over and over in the marketing of egg freezing,” she told seminar attendees at Deakin University last year, “and it’s really not an insurance policy. It’s very expensive and uncertain technology.” As Dr Tessa Copp, from the University of Sydney’s School of Public Health puts it, “It’s not an insurance policy. It’s a lottery.”

All of which makes you wonder. Can women really relax about egg freezing? Is it safe? Is it affordable? Is it even necessary? And most of all, does it work? Does egg freezing actually ensure that a woman can still have a baby, at a point when her own body’s biological clock has told her that the time for babies is over?

Egg freezing at Number One Fertility clinic in Melbourne.Credit: Josh Robenstone

Revolutionary rise

Once upon a time, I was in my 30s, single and loved the idea of being a mother. Meeting a partner, I had decided, was in the lap of the gods. But a baby needed planning. So I investigated egg freezing.

Back in the dark ages of 2010, when I was looking, the news wasn’t good. The egg is the largest cell produced by the human body – some 8000 times the volume of a sperm – and contains a lot of water. Traditional freezing techniques were perilous, because ice crystals, forming from this water, could pierce the cell’s membranes and destroy its internal structures.

This is why no one told Jennifer Aniston to freeze her eggs, and why a million other Gen X women didn’t do it either: the tech really wasn’t up to the task. Success rates were so low that, until the second decade of this century, the only women who generally considered egg freezing were those at risk of total fertility destruction from medical treatment regimens like chemotherapy. Then, from 2012, a new freezing technique called vitrification entered mainstream medicine.

Vitrification uses cryoprotectant chemicals to pull the water out of an egg, then freezes it extremely rapidly. “Once you’re in the really high-concentration solution, you normally have between 30, 40 seconds to take it from 37 degrees Celsius to minus 196,” says Professor Deirdre Zander-Fox, chief scientific officer of Monash IVF Group. This process “transitions the egg into a glass-like state [so quickly] that you’re sort of bypassing ice-crystal formation”.

Vitrification revolutionised egg freezing. By 2015, both Apple and Meta (then Facebook) in America were offering it as a benefit for their female employees; in 2016 the US military introduced it as a free option for active servicewomen (servicemen are able to freeze their sperm). Today, more than 60 countries perform the procedure; in the US, the number of cycles occurring each year rose by 400 per cent between 2012 and 2020. In the UK during the same period, the numbers increased by more than 1000 per cent.

Egg freezing in Australia, however, outstrips both. Between 2012 and 2022, Australia experienced a 1400 per cent increase in the number of cycles being performed: from some 414 in 2012 to 5815 in 2022 (these figures include New Zealand, which represents about 7 per cent of the combined figure). In 2022, the UK, despite having almost three times our population, performed only 4600 cycles.

For clinics, these kinds of numbers require serious logistical planning. Dr Lynn Burmeister is founder and head of No. 1 Fertility in Melbourne; she has a new clinic set to open in Sydney in May. She estimates egg freezing makes up 50 per cent of her business; her clinic has about 20,000 eggs in storage. “I’ve seen other clinics run out of space,” she says. “We have our own on-site liquid nitrogen production, and our two huge egg-freezing rooms are the [combined] size of a basketball court. I think we’re going to need a third.”

‘I was very determined to try my best to increase the chances of having a child.’

Anh Tran

Anh Tran, a medical information specialist living in Melbourne, froze her eggs in 2023, when she was 35. Because many clinics advise women to try for 20 eggs to maximise their chances of a live birth, Tran did four separate cycles and documented her journey on Instagram: everything from bursting into tears in the parking lot of the clinic to worrying about revealing her tummy while doing injections on camera. It was, she says now, an overwhelming experience.

“Even though I was eligible for Medicare, it was still between $4000 and $5000 each round, plus extra,” she explains. (Unlike many Instagram influencers, Tran did not receive her egg cycles for free; nor was she paid.) “And it’s very emotional. I thought two rounds would be enough but in my second round I only got two or three eggs. I was devastated. I was like, ‘Oh my god, that’s 10 or 12 grand down the drain and I still don’t have enough. I thought I was going to use my savings on other things! Do I really want to spend more money that I don’t have?’ ”

In the end, Tran, who broke up with her boyfriend between cycles, spent some $30,000 to freeze 30 eggs. “It was difficult,” she says. “You’re supercharged on hormones, you’re spending so much money. But I was very determined to try my best to increase the chances of having a child.”

Anh Tran spent $30,000 to freeze 30 eggs when she was 35, recording events on Instagram.Credit: @crazy_anh/Instagram

Four cycles of egg freezing for $30,000 is pretty standard in Australia, where a single unrebated cycle costs between $5000 and $10,000, plus storage costs of about $500 a year. Add to this the potential for extra cycles in pursuit of the magic “20-egg” figure, plus the IVF costs involved in any eventual attempt at pregnancy, and it’s clear how lucrative this still largely untapped sector of the $US34.7 billion ($55.5 billion) global fertility industry may become. It’s no accident, perhaps, that two of the three largest egg-freezing providers in Australia, Genea and IVF Australia, are owned by private equity firms. As British medical journal The Lancet put it last year in reference to the fertility market as a whole, “the money to be made is staggering”.

Indeed, from a business perspective, egg freezing sounds like all upside. As one clinician points out: “Egg freezing doesn’t take much clinic time: it’s not as labour-intensive on our side [as an IVF cycle].” As for storage, “I once ran the numbers on one of the big centres, and they are easily making more than a million dollars a year in revenue just from storage fees alone.”

For the women at the other end of the transaction, however, the calculus is different. For starters, egg freezing is, for many women, so expensive it’s simply not an option. “Some women just rule themselves out based on the cost,” says Dr Michelle Peate, a researcher at Melbourne University Medical School. “Good or bad, it’s an option that only certain women can access.”

Of course, not all fertility clinics are rapacious money-making machines. And certainly, the fertility clinicians I spoke to were thoughtful and honest. They recognise the conflict in their own business model. “It’s a problem,” admits Devora Lieberman, medical director of City Fertility clinic in Sydney’s CBD. “We do have a commercial interest, a financial interest, in getting people to do the freezing.”

Lieberman has been in the business for almost four decades. “I start most of my consultations by saying I’m probably one of Australia’s biggest believers in egg freezing. But I do try to talk most women out of doing it because statistically, less than 10 per cent of women who freeze eggs will come back for them. They’ve got a 90 per cent chance of going through this process and never coming back.”

The fear factor

Why is it that so few women who freeze their eggs actually use them? Perhaps the major reason is that frozen eggs are a last resort, and women end up having babies naturally. For women who are very young, this is especially true: in her 20s, a woman has a high chance of both finding a partner and of having a baby naturally if she wants one: she is, by definition – and basic biology – the last person who should be worrying about fertility.

And yet it’s exactly this group that egg-freezing advertising increasingly targets, mostly via social media – women in their 30s, but also in their 20s. “A lot of this advertising is problematic,” explains Dr Karin Hammarberg, one of the world’s first IVF nurse co-ordinators and senior research fellow at Monash University. “It really comes through so strongly in the social media sphere: the overstating of the benefits and the non-mentioning or understating of the risks, costs and potentially negative outcomes. It really creates an imbalance that doesn’t help people make good, informed decisions.”

‘Egg freezing is a technological solution to a social problem.’

Marcia Inhorn

Among these risks are the potential health consequences – most significantly the rare, but potentially serious (even, in a very small proportion of cases, fatal) Ovarian Hyperstimulation Syndrome (OHSS). There are also weeks of daily hormone injections to stimulate egg production (identical to IVF), and a medical day procedure under sedation to collect them. As Marcia Inhorn puts it, “It requires bravery. It’s a month of your life. And what are the implications for the future?” The only way to get pregnant with frozen eggs is via IVF; and pregnancy and childbirth in older women – the implicit end goal of egg freezing – “does carry higher risks”, explains Tessa Copp.

Social-media advertising is silent on these issues; what it does do is raise alarm bells with lines like: Did you know you lose several eggs from your egg reserve every month? or By the time she returned to freeze her eggs, it was too late. “What upsets me is that some of it is quite predatory and preys on women’s fears,” acknowledges Devora Lieberman. “To my mind, egg freezing should be empowering. You should not be frightened into doing it.”

Devora Lieberman of Sydney’s City Fertility clinic tries to talk most women out of having their eggs frozen.Credit: Peter Rae

But fear is a powerful motivator. “We’re definitely seeing a shift to younger women,” says Lynn Burmeister. “A lot of the young lawyers I’ve seen are doing it because they want to be partners, and they say that will take them another six to eight years. If they have a baby, they’re scared they’re not going to get to that top tier. And I’ve had doctors [in their 20s] doing it who want to be specialists. I’ve even recently seen a 21-year-old. I turned her away. She had no risk factors of menopause; her [hormone levels] were good. I said to her, ‘Come back in a few years if you still feel the same.’ ”

Of course, egg freezing does nothing to address the real-world social issues these women are facing: women’s career trajectory after childbirth; parental leave; childcare provisions. As Marcia Inhorn puts it, “Egg freezing is a technological solution to a social problem.” It gives women the option of altering their biology to fit social expectations, “but it doesn’t solve those social problems,” explains Tessa Copp. “It doesn’t solve work/life problems, it doesn’t solve relationship problems.”

Jessica Leung is a portfolio manager at a financial services institution in Sydney. She’s now 32, but she remembers talking about egg freezing with med-school friends in her mid-20s. “I would tend to classify myself as a career-driven woman, so I’ve always been pondering those thoughts about work-life balance, family, what comes first.” She recalls the decision to do a cycle at 30 – which cost her $10,000 and yielded eight eggs – as “straightforward”.

What wasn’t straightforward was work, where she had to request leave not only for the collection procedure itself, but also for appointments before and after; she kept working, as most women do, through the daily hormone injections. She was the first person ever to raise the topic (with her male manager) at her company. “I was lucky – my workplace responded very well. But I can see that there’s still a long way to go. Working up to those conversations was a lot.”

Leung, perhaps surprisingly, has a long-term partner. He took no part in the egg-freezing decision – or its costs. “But he was so supportive – he was the one who did the injections for me every single day.” He is also open to freezing embryos (something else Leung is considering), or adoption, or no children. “He has always been very open – and I’m very grateful to not have any pressure from a partner saying he does or doesn’t want kids. But then at the same time, it means that there’s even more pressure for me to know exactly what I want!”

What Leung really wants “is optionality. I’m young, I want to freeze eggs while they’re young and healthy. Who knows what will happen in the future? Who knows if [my partner and I] will be together? And I do really love my career and I want to continue pursuing it. So I don’t want to be in that situation down the line where I do decide I want a child, but I don’t have the eggs.”

Numbers game

So what about these eggs? What, exactly, are the chances that one of them will actually make a baby?

The short answer is: higher than they’ve ever been. Subject to your age, health and genetics, and the clinic you choose (“not all clinics are created equal” points out Hammarberg), your chances of a live birth from 20 frozen eggs could be as high as 90 or 95 per cent.

The longer answer is: it depends. Being young at egg collection improves the quality of your eggs. It also raises your (low) risk of OHSS. Having more eggs stored makes it more likely you will have a live baby. (It also means you might end up with the option of more cycles of IVF than you’re willing to go through, or more eggs you’re not sure how to dispose of. There’s a general storage limit of 10 years in NSW and Victoria, and there are currently few options to donate eggs to scientific research. Gifting eggs to other women is difficult both legally and, research shows, emotionally.)

And one final complexity: some eggs will make a baby, and some won’t, and ultimately nobody, anywhere, has figured out how to tell the difference. “We cannot tell the quality of any egg until we put it with sperm,” says Burmeister. Professor Beverley Vollenhoven of Monash IVF agrees. “I can’t tell you – no one can tell you – that if you want three children, you should have 60 eggs,” she says. “I keep saying to people, ‘You may have 60 eggs and never get pregnant.’ ”

Monash IVF’s Beverley Vollenhoven: “I keep saying to people, ‘You may have 60 eggs and never get pregnant.’ ”

Victoria Thomas* is a primary school teacher in Melbourne who always envisaged herself as a mum. Aged 34, she froze 28 eggs in a single cycle. Statistically, her chances of having a baby – somewhere above 90 per cent – could not have been better. When she turned 40 with no partner, she decided to forge ahead, using donor sperm. “Of 28 eggs, 24 or 25 thawed successfully,” she recalls. “So I was feeling pretty cocky. And then after fertilising, the day before my transfer, there were 11 embryos.”

Thomas has a bright, enthusiastic voice – a voice to inspire little kids – so her next words are completely unexpected. “By the transfer, there were only two left. I went in and had the first one transferred and it didn’t take. I was absolutely gutted.”

You know how this story ends – or do you? Thomas had that second embryo transferred in December – and her baby is due in August. “Obviously I am beyond thrilled. But I am your absolute Hail Mary scenario. And I realised between the first and second transfer that actually, egg freezing had been this security blanket for years. I knew it wasn’t a guarantee, but I was cocky.”

If you freeze eggs, are you less likely to try other avenues for having a baby? Less likely to try to meet a partner? Less likely to carve time out from your career to become a mother? “I always say to patients, ‘If you want to have a baby, have you thought about getting pregnant now?’ ” says Vollenhoven. “The only way you truly know is if you try.”

More and more women are doing this, she adds. “I mean, probably a third of women who come to see me about egg freezing actually change their minds and look at pregnancy. Single, heterosexual women. That’s going to be really interesting in future: more women choosing to have children in the absence of men. It’s going to change society.”

‘You’ve got this situation where women need to take their fertility entirely into their own hands because men are in denial about it.’

Professor Beverley Vollenhoven

Men are the single biggest reason women freeze eggs. Or rather, the absence of men. “Women are attempting to preserve and extend their fertility because they cannot find stable, committed reproductive partners, even though they want them,” says Inhorn. Or, as Vollenhoven puts it: “The pool of men out there is like a muddy puddle.”

“The irony is that men want children just as much as women do,” says Hammarberg. “We’ve done the research, and if you ask young men, all of them say, ‘Yeah, I want children and I plan to have children.’ The problem is that men are not well-educated about fertility, especially female fertility. And if you’re not aware of the biological limitations of a woman’s fertility, it’s very easy to say you’re not ready and you want to wait. Lots of men think that a woman’s fertility doesn’t start to decline until after 45.”

In fact, the chance of a woman having a child aged 45 with her own eggs, even with the help of IVF, is tiny: less than 5 per cent. Men also significantly overestimate the success rates of IVF, adds Hammarberg, so they have a false sense of security about the options if natural conception fails. “The reality that comes through very loudly is that men, they’re never ready. We need to have much more proactive [fertility] education for men. They need to be actively engaged in reproductive decision-making.”

As it is, men are often reduced to caricature roles in the egg-freezing world: as fertility vampires (men who stay with partners through their child-bearing years, then leave when it’s too late for them to have a baby) or Peter Pans (men who don’t grow up). This is a tragedy for men as much as women – research on involuntary childlessness among men indicates it can cause long-term grief, reduced quality of life, and feelings of loss, depression, exclusion, isolation and risk-taking behaviour.

Does egg freezing solve this problem? It’s hard to say. But what it doesn’t do is encourage men to step up to the fathering plate – quite the reverse. Egg freezing, almost by definition, puts all the pressure on women to take responsibility, bear the costs, and carry the emotional – not to mention physiological – load.

“But hasn’t that always been the case?” asks Vollenhoven. “Think about contraception. Women had no choice in having multiple children because there was no contraception, then women were expected to take responsibility for all contraception. And now you’ve got this situation where women need to take their fertility entirely into their own hands because men are in denial about it.”

Having been at the mercy of the singles scene, or involved in relationships with men unwilling to parent, these women want some sense of control about the future, she says. Whether egg freezing gives them this is not clear. “During COVID, nothing was in our control,” Vollenhoven says. “Now we all want to be in control, all the time, of everything. But the reality is, who knows what’s going to happen? People want guarantees, but I can’t give you guarantees. These things are all unknown, and it’s very hard to accept the unknown now. Hard for everyone. But well, that’s life.”

Safe keeping

Lucy Ormonde doesn’t sound like a control freak: she sounds smart and fun and slightly world-weary. But she did want to do what she could to give herself a chance of a child. “I was single, living a very fast, fun, life – travelling the world, working, just having a great time. It wasn’t top of mind.”

Nonetheless, she always promised herself she’d look into egg freezing when she turned 32. “And 32 came and went and I did not do that,” she laughs. She eventually froze her eggs in 2023, aged 36. She found the process less arduous than she was expecting: she did two cycles and got 23 eggs. “So by October, life was looking pretty shiny.” She pauses. “And then in November, I found a lump in my breast.”

Lucy Ormonde (pictured at her first chemotherapy treatment) was “really glad” to have had 23 eggs frozen one month before she discovered she had breast cancer.

Shockingly, Ormonde had stage three breast cancer. But thanks to her own forward-planning, she’d already done everything she could to protect her fertility: she actually was more in control of this aspect of her life than anyone, including herself, had expected. “My oncologist was relieved, needless to say!”

Nonetheless, Ormonde did one more cycle of freezing before she started chemotherapy: she now has 33 frozen eggs. “Cancer is not what I was insuring myself against when I started [egg freezing],” she says. “But now I’m really f---ing glad I did it. It’s not just about whether or not you meet the right partner: things happen in life that you’ve never thought about. I’m proud of myself: that I could afford it, that I’d taken the steps to prepare for my future.”

Ironically, cancer has also clarified that her original decision was correct. “When I got my diagnosis, the first thing I asked, pretty much, was, ‘How will this affect my fertility?’ It became very, very clear to me – almost literally in that moment – that kids were really important to me.”

Whether they end up having children or not, few women regret egg freezing. They say they’re glad they were proactive; glad they did what they could when they had the chance. And glad that, if all else fails, they have this final option of at least trying to have a baby.

‘Parts of the process definitely felt like a money-making exercise for the clinic.’

Celia Zara*

Celia Zara – she of the curling hair and gesturing fork – did exactly that. She and the Fulbright scholar stayed together, married and had a son naturally in 2021, when Zara was 39. But when she tried to fall pregnant again at 40, she had no luck. As a last-ditch effort, she turned to her frozen eggs in February last year.

“Parts of the process definitely felt like a money-making exercise for the clinic,” she says. “They kept trying to get me to do a fresh cycle [of egg collection], which was much more expensive than using my frozen eggs. But those [frozen eggs] were seven years younger, and I was like, ‘Well, isn’t this what they’re actually for?’ ”

The process of having her fertilised egg implanted (her 13 eggs yielded five embryos) also left a bit to be desired. “It was a cross between The Handmaid’s Tale and a cow-milking factory,” she recalls. “There were all these women waiting for the lifts to open at 7am in this big CBD building, and we all went up and registered, and you think you’re going to be waiting for ages, but within 10 minutes everyone was through. It was super-efficient, super-impersonal.”

But it worked. She fell pregnant with the second embryo she had transferred, and the only one she was able to get genetically tested. In December last year, her baby – a healthy boy – was born.

This little boy is the product of all egg freezing’s fundamental paradoxes – extraordinary technology and basic biology; calculated profit-motive and altruistic science; impersonal efficiency and individual emotion. But mostly, like all babies, he’s a miracle in the oldest sense of the word: an object of wonder. Collected, frozen, thawed, fertilised, re-frozen, re-thawed, implanted, born.

“Yes,” says Zara. “When you look at it like that, it’s pretty amazing.”

* Names have been changed.

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