Oocyte Cryopreservation: The Next Wave of Assisted Reproductive Technology, or Marketing Ploys for Career-oriented Women?

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Women's Health Activist Newsletter
July/August 2008

By Kiesha McCurtis

A combination of increased access to birth control, education, and professional opportunities has lead women in the United States to delay motherhood. More women are postponing childbearing to pursue professional degrees, demanding careers, travel, and “me time.” Today, 20 percent of American women have their first child after age 35, compared to just 3 percent in 1980.1,2 Although many causes of female infertility are not age-related, a woman’s ability to conceive does decline significantly with age. Hence, as women delay childbearing, new reproductive technologies are being created to support their needs and address the conflict between increased career opportunities and the reality of aging female fertility. Sadly, the newest of these methods poses harmful side effects and only a small chance of success, while securing large profit margins for egg banks and specialized fertility clinics.

Women’s eggs are unique in that they don’t replenish themselves the way most cells do. Women are born with all the eggs they will ever have and, as they reach their 30s, the eggs’ general health naturally begins to decline. Women also ovulate less frequently as they age, although they may still experience regular menses until the few years leading up to menopause -- when menstrual cycles become more irregular before ceasing completely. No amount of exercise, vitamins, or Botox can slow down or halt these processes.

Biologically, the ideal time for a woman to get pregnant is in her 20s but, for many Western women, that is a period better suited for laying the foundation for a strong career path or pursuing personal interests. After age 35, however, a woman’s fertility not only drops off precipitously but her older eggs also become more prone to chromosomal abnormalities. So, while women can still carry a pregnancy to term after 35, the age-related decline in egg quality makes conception much harder and increases the risk of birth defects.

As more women delay pregnancy, assisted reproductive technologies such as in vitro fertilization (IVF), surrogacy, and special line fertility drugs have assumed a more prominent role in the field of reproduction. Recently, fertility doctors have begun to promote egg freezing as a new response to reproductive aging. Egg freezing (also called “oocyte cryopreservation”) is an assisted reproductive technology in which a woman’s eggs are extracted, frozen, and stored for her; they are later thawed, fertilized, and implanted in her uterus when the woman is ready for pregnancy. The technology necessitates women taking two weeks of intensive ovary-stimulating hormones in order to encourage the body to produce multiple, mature eggs in a single cycle instead of the typical one or two eggs per cycle. The eggs are removed through the vaginal wall using a long needle, then frozen and stored. When the woman is ready to become pregnant, multiple eggs are thawed and fertilized in vitro with her partner’s sperm. Those fertilized eggs are then implanted into the woman’s uterus and any embryo that survives the process develops into a fetus. Two to three eggs are usually thawed and fertilized to increase the odds of a successful procedure.

The procedure can cost upwards of $10,000 – and that’s not including the annual storage fees for the eggs. It is unlikely that the price tag on this brand of hope will drop in the near future, and most insurance policies do not cover the procedure for healthy women. Egg freezing is costly not only because the technology is expensive but also because it is still considered an experimental fertility procedure with little evidence that it works. The American Society for Reproductive Medicine (ASRM) warns that -- in addition to the steep price -- this investigational technology has actually had very little success given the number of births that have occurred from frozen-and-thawed eggs. For every 100 eggs that are extracted and frozen, only 2 will survive the process and have even the potential to result in successful, live births when they are implanted later on.3

What’s more, the ovary-stimulating drugs the woman must take for two weeks prior to extraction have significant potential side effects. In addition to irritation or infection at the hormones’ injection site, these include: depression, hypertension, chest pain, thyroid abnormalities, night sweats, muscle pain, joint pain, bone pain, and loss of libido. Nearly all of the hormones used in egg freezing process carry a risk of ovarian hyperstimulation syndrome (OHSS). Between 10—20 percent of women who use ovary-stimulating drugs experience mild forms of OHSS, which has symptoms such as nausea, vomiting, and diarrhea. Tragically, the more severe forms of OHSS can be life-threatening.4

The science in the field of assisted reproduction is advancing rapidly, but most experts agree that egg freezing is not an effective way to defer reproductive aging. ASRM’s position is that while egg freezing may be appropriate for women with cancer or other extreme illnesses that result in infertility as a result of treatment (such as chemotherapy), the investigational procedure is far from ready for mainstream use by otherwise healthy women. A more reliable (and safer) alternative is to freeze either sperm and/or embryos (fertilized eggs), which is fairly easy to do and has a higher success rate for eventual pregnancies.5 Those procedures have been available for years and are very effective in helping both men and women conceive.

Egg freezing, on the other hand, is considerably more difficult and has a lower rate of success. The eggs are frozen using a special slow-freeze formula that dehydrates them. Before implantation, this freezing process must be reversed and the eggs thawed and re-hydrated back to their original state. But eggs are fragile and contain a lot of water – making them vulnerable to formation of damaging ice crystals. As noted above, the odds that stored eggs will survive this freezing and thawing process in a viable form are very low. Combine low survival odds with the myriad of potential side effects that ovary-stimulating drugs carry, and the whole procedure begins to sound more like a marketing ploy aimed at aging and anxious women than a reliable reproductive technology.

Egg freezing is distinctly different from other assisted reproductive technologies because it is not being marketed as a response to existing infertility or impending infertility (e.g., for women preparing for cancer treatment). Rather, it is being pitched as a viable guarantee for women who are not yet ready to have children, but who want to improve their odds of childbearing in the future. One company, Extend Fertility, states: “Fertility. Freedom. Finally. Extend Fertility's breakthrough egg freezing service offers women the opportunity to preserve their fertility and take control of their reproductive health.” The language gives the impression that this risky, experimental technology is actually an effective means of fighting age’s effects on fertility. The marketing plays on the fact that the average 30-year-old woman has a 20 percent chance of conceiving on any given menstrual cycle without fertility interventions, while the average 40-year-old has only a 5 percent chance.6 (This doesn’t mean a 40-year-old cannot conceive and carry a pregnancy, just that it will probably take more cycles for her to become pregnant than it would for a younger woman.)

We know that, as women age, her chances of conceiving become progressively lower over time, but statistics only tell us about the likelihood of conceiving in general. Statistics say nothing about a woman’s individual chances of conceiving and carrying the pregnancy to term. Advocates of egg freezing use alarming statistics in a misleading fashion to encourage women to create unnecessary back-up plans based on an ineffective, expensive, and unproven technology. In fact, research shows that women who freeze their eggs before the age of 35 are likely to never need or use them.7 The vast majority of women not only marry by age 35 but also have a low risk of infertility.

 

REFERENCES

1. National Center for Health Statistics, Health, United States, 2005, Washington, DC: HCHS, January 2006. Accessed June 4, 2008.

2. The American Fertility Association, Age and Fertility, Dobbs Ferry, NY: American Fertility Association, 2008. Accessed May 12, 2008 from: http://www.theafa.org/library/article/age_and_female_fertility.

3. Oktay, K. AP Cil, H.Bang, “Efficiency of oocyte cryopreservation: a meta-analysis,” Fertil Steril 2006; 86:70-80.

4. The Mayo Clinic, Infertility, Rochester, MN: The Mayo Clinic, June 2007, 1-16. Accessed May 13, 2008. Available online: http://www.mayoclinic.com/health/infertility/DS00310.

 

5. American Society for Reproductive Medicine “Essential elements of informed consent for elective oocyte cryopreservation: A practice committee opinion,” Fertil Steril Dec. 2007: 88(6) p.1495-1496.

6. The American Society for Reproductive Medicine, Age and Fertility: A Guide for Parents, Birmingham, AL: ASRM, 2003, pgs 3-4. Accessed May 13, 2008. Available online: http://www.asrm.org/Patients/patientbooklets/agefertility.pdf.

7. Age and infertility. Menken J, Trussell J, Larsen U. Science 1986; 233: 1389-94.

 

Kiesha McCurtis is the NHWN Health Information Coordinator