Fertility ‘insurance’: is it worth freezing my eggs?
More and more women are choosing to store eggs to ‘protect’ their fertility. But with the cost rising, is it time for us to consider an egg bonus?
Thousands of healthy Australian women freeze their eggs each year and the number is increasingly rapidly. Indeed, across the past couple of years that figure has almost doubled.
Egg freezing is invasive, intense and expensive, costing much more than $10,000 upfront, plus annual storage fees, but is it worth the investment? Australian women collectively are spending millions of dollars on what is pitched as “fertility insurance”. The million-dollar question that seems to be on thousands of lips is: Should I freeze my eggs until it’s the right time to have a baby?
Interest in egg freezing is reaching fever pitch. It also is a significant money-spinner for Australia’s IVF industry. Social media is awash with stories about putting eggs in the freezer while women pursue career or travel goals, or await the right partner.
Interest in egg freezing has grown from scientific work initially aimed at helping women facing a cancer diagnosis.
In the past many young women who received a cancer diagnosis might never have children. Chemotherapy could damage the ovaries and many years of hormonal treatment while they were in remission affected their fertility. Large numbers of women found themselves cured of cancer but unable to have a family.
To help them, research was undertaken on freezing eggs in the brief window between receiving the diagnosis and starting chemotherapy. Results in the early days were disappointing.
Human eggs are fragile and a slow-freeze process often resulted in ice crystals forming within the eggs that damaged their delicate genetic material. Most did not survive after they were thawed.
The breakthrough came with the development of snap-freezing techniques. This proved revolutionary and allowed women to have IVF treatment across a couple of weeks and for the eggs obtained to be frozen with good confidence they would survive when thawed.
As this IVF technique matured and came into common use, new uses for egg freezing came into play. One of these was offering women the option of freezing eggs for no other reason than having a baby plan B. By 2022, almost 2000 women chose “fertility preservation” for non-medical reasons.
Large companies hit the news by offering to cover the costs of egg freezing for female employees. Women shifted the dial forward from baby showers to having “egg shower” parties. Social media lapped all of this up.
Where does the truth lie? There is so much interest in egg freezing that the government’s IVF success website soon will be adding an egg freezing calculator to its suite of consumer tools.
To step through the decisions women have to make if they’re considering egg freezing, several things are important. What does egg freezing involve? How long will the eggs last when they’re frozen? What are the chances of having a baby if the eggs are thawed?
Obtaining eggs to freeze involves the first half of an IVF treatment. In a typical month, women’s ovaries will develop one egg that is released in the mid-cycle. IVF methods override this and, with the use of injections, a crop of eggs develops on the ovaries.
Once the eggs reach maturity – typically after about two weeks of daily injections – they are collected. This involves a trip to the day procedure centre, sometimes sedation by an anaesthetist, and the use of a long needle through the upper vagina under the guidance of an ultrasound machine.
Eggs that are collected are checked by IVF scientists and, if suitably mature, can undergo the snap-freeze process and remain in storage. Most women recover across a couple of days and can resume their lives with no restrictions. Complications of the process are uncommon but occasionally can be serious.
The good news is that eggs can survive in the freezer for many years. When healthy eggs eventually are thawed, more than 80 per cent will be healthy and suitable to fertilise. Many fertilised eggs will develop into embryos suitable to be transferred back to the woman’s uterus.
“How many eggs do I need to freeze to be reasonably sure of having a baby in the future?” is the obvious question almost all women ask. Like so many things in healthcare, the answer may not be so clear.
One factor that can affect the answer is a woman’s age at the time her eggs are frozen. The information underpinning this is reasonably certain on one thing – freezing eggs in a woman’s mid-30s is better than doing it later in life.
Women who freeze eggs before the age of 37 will need to store between 15 and 20 eggs to have a 75 per cent chance of having a baby. That will usually involve one or two rounds of ovary stimulation and egg collection.
A recent analysis that looked at all of the available data suggested the following rule of thumb to guide women. To have a 75 per cent chance of taking a baby home, a 34-year-old should freeze 10 eggs, a 37-year-old 20 eggs and a 42-year-old a whopping 60 eggs.
The older a woman is, the more eggs will need to be frozen to be confident of taking a baby home. The problem with this calculus is that, with increasing age, the way ovaries respond to IVF injections falls and each treatment tends to yield fewer eggs.
Women in their early 40s who freeze eggs most likely have a chance of having a baby of less than 20 per cent. Decision-making is difficult because it may not be obvious that they may wish for egg freezing when they are younger.
In the modern world these are very difficult decisions. Even in an era of AI-powered dating apps and social media connection, finding a person with whom you may want to have a child is not easy for many people.
With the cost of egg freezing beyond the reach of many single women we need to make a decision, as a society, about how much we value children. In the early noughties, federal treasurer Peter Costello famously asked Australians to have one baby “for the country” and offered the baby bonus. Is it time for an egg bonus?
As things stand, it seems likely that most women who freeze their eggs won’t end up using them. Many will end up meeting a partner and starting a family the old-fashioned way. Some will look to donor sperm and use treatments such as insemination. Others will opt not to become pregnant.
As Australia’s birthrate continues to fall, and large numbers of people choose to have a single child, the way we think about having the next generation is changing.
The cost-of-living crisis, worries about climate change and other future risks, pursuit of career and other life goals all seem to be affecting Australians’ family plans.
If you’re at a point of thinking about freezing your eggs, my advice is to see an expert in the field and steer clear of social media pundits. Have a bespoke assessment and a frank discussion. Most of all, few women need to rush the decision. This is definitely one to sleep on.
Steve Robson is professor of obstetrics and gynaecology at the Australian National University and former president of the Australian Medical Association. He is a board member of the National Health and Medical Research Council and a co-author of research into outcomes of public and private maternity care.
This column is published for information purposes only. It is not intended to be used as medical advice and should not be relied on as a substitute for independent professional advice about your personal health or a medical condition from your doctor or other qualified health professional.
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