To Freeze or Not to Freeze

As a woman who had her first child at 36 and her second at 40, I have found this assertion suspicious to say the least. In 2000, pregnant with my first son, I was routinely referred to as an “elderly primp” (primp is short for primiparous, or first pregnancy). I did require IVF for my first child, but not for age related reasons. My second pregnancy 5+ years later, was spontaneous and somewhat unexpected. At 36, I certainly did not feel elderly. For that matter, now at 48 and the mom of 2 young boys, I still don’t feel elderly. This terminology predates the current media hype about pregnancy over 30, yet there is clearly a continuing condemnation of women who choose to delay childbearing for whatever reason. Whether it is labeling us as elderly or fear mongering with the threat of a childless life as the cost of delay there is enormous social pressure around this issue, despite the great strides women have made towards equality in the past half-century.

I have spent an extraordinary amount of time reassuring my patients over 30 that their reproductive futures have not ended. It makes me sad that so many talented young women doubt their life decisions to delay childbearing. It also infuriates me. There is clearly a social agenda here: women who pursue a non-child oriented life path over early childbearing are to be chastised and bullied.

Egg freezing has been put forward as the way to “have it all”. What is generally neglected in the articles touting the benefits of cryopreservation is the cost, both monetary and medical, and the truth about the outcomes. While freezing your eggs certainly is a way to hedge your bets if you are in your 30’s with no baby-making prospects in the foreseeable future, it will also cost you $10-20,000 per harvest. You will need to inject yourself with powerful hormones to force your ovaries into a “hyper-ovulatory state” and then undergo an egg retrieval procedure. I’ve done this myself as part of an IVF cycle: it’s not fun.

Once the eggs are harvested, you have to pay to keep the eggs on ice until you are ready to use them. At that point you will need to pay more to have the eggs thawed, fertilized, cultured, and then replaced into your uterus for gestation, and hopefully a live birth. Of course, not all of your eggs will thaw well; not of the properly thawed eggs will fertilize; not all of the fertilized eggs will go one to make a healthy embryo; and not all embryos will go on to produce a full term normal baby. In December 2012 and article in the American Journal of Obstetrics and Gynecology  estimated that the number of live births per thawed egg was 2-5%. There are a huge number of steps from frozen egg to live baby, many of which are far beyond our control.

That is not to say that freezing your eggs is a bad idea. It is to say that, if you choose this path, do so with your eyes wide open. Know that you may loose on your investment and be sure that you have not over extended yourself monetarily or emotionally in the process.

So now you are probably wondering what in the world to do as you enter your thirties and worry about that steep decline into infertility. Well, the decline is not that steep and, contrary to the overwelming public percept, the prospect of having babies is not past. Happily, the Atlantic Monthly published a wonderful article this month BY Jean Twenge, eloquently discussing “older” motherhood.

 

In principle, I have no problem whatsoever with the notion of egg freezing. As long as you know what you are investing in and feel good about it, they absolutely GO FOR IT. My issue is that women over 30 have been terrorized into believing that they may never have children and should pursue this expensive procedure to make up for their childbearing delay. Women over 30 have not reached the end of their fertile lives, and they don’t need to be bullied into having children early. In fact, I feel deeply that I am a wiser and better parent in my 40’s than I could have ever been in my younger years. None of us can “have it all”, but we can come close, and we can come a lot closer than the current media maelstrom would have us believe.