Despite the buzz about egg freezing, cost has always been a barrier for most women. Since the procedure allowing women to store their eggs until they’re ready to reproduce became available in the U.S. a decade ago, the price has hovered between $9,000 and $13,000. And that’s just for office visits, extraction surgery, and freezing. Medications and storage (never mind thawing and fertilization years later) add on thousands more. Egg freezing generally is not covered by insurance, unless you’re freezing to preserve your fertility before being treated for cancer. As a result, it’s mostly been a luxury for wealthy women or those willing to shoulder crushing credit-card debt. According to a recent piece in the Wall Street Journal, many women are setting up separate savings accounts just for egg freezing. Sometimes, parents chip in by dipping into their retirement nest eggs. Or women get creative: When I froze my eggs five years ago, I saved money by traveling to Canada and buying generic Spanish fertility drugs through a British online pharmacy. I’ve also heard about women trolling in-vitro fertilization message boards asking for other patients’ leftover drugs.
Besides the obvious financial sting, the high cost makes it harder for women to use egg freezing effectively to give them the best chance of bringing home a baby later.
Patients often waste precious years trying to save up enough money, while their egg quality declines. Although doctors recommend patients buy several rounds of egg freezing—to save a total of 20 or so eggs—many women are lucky enough to afford one cycle. And despite the it-takes-a-village appeal of women helping women, trading fertility drugs is not the wisest move. In the meantime, many women have been quietly waiting for prices to drop.
Yet there’s a kind of egg freezing that uses a cheaper controversial drug regimen that many women don’t know about. Long used in Europe and Japan, so-called “minimal stimulation” has been slow to take off in the U.S. and is offered by just a handful of American clinics. Practitioners such as Dr. Sherman Silber, a fertility doctor in St. Louis who offers minimal stimulation for $2,000, says the approach uses about one-tenth of the amount of drugs than the typical protocol, eliminates the risk of hyperstimulation, and is gentler on women’s bodies (and moods!).
Here’s how minimal stimulation differs from the traditional method: During a typical cycle of egg freezing or IVF, a woman injects herself usually twice daily for 10 days with hormones that make anywhere from 10 to 20 eggs. If she’s undergoing IVF, the eggs are collected during surgery, fertilized, grown into embryos, and transferred to her uterus several days later. If she’s freezing eggs, they’re whisked to the freezer for later use. Yet with minimal stimulation, patients take the oral ovulation induction drug clomiphene citrate and only five or so hormone shots over the same time period. The extra cost for the drugs runs between $500 to $1,000 compared to $2,000 to $4,000 for the traditional regimen.
There’s a major downside, however: Women produce far fewer eggs—three to seven at a time as opposed to 10 to 20—which is hardly appealing if you’re trying to stash away a cache of frozen fertility. Yet Dr. John Zhang, whose price for minimal stimulation ranges from $5,000 to $9,000 in Manhattan, insists those eggs are the most likely to make babies. “The ovaries have limits to producing good quality eggs,” he says. “No matter how many eggs you produce per cycle, you don’t have more than three to four good eggs that can result in live babies.” Plus, the “less is more” approach is better for older women or those with a low ovarian reserve, since they’re likely to produce fewer eggs anyway. Zhang says that minimal stimulation enables him to accept women in their early 40s who many mainstream clinics turn away—these clinics believe it’s not worth putting these women through the harsher, more expensive regimen to collect a handful of old eggs and expose them to the stress of freezing (and also not worth risking their practices' future success rates when those eggs are thawed).
The approach is also cost-effective for doctors, since they spend less time during every part of the process—from administering vaginal ultrasounds, harvesting eggs during surgery, and freezing them—because they’re dealing with fewer eggs.
So why don’t more clinics offer it? Well, for one, the drug protocol isn’t that much easier. I was lucky to learn of the minimal stimulation option in the earlier years of egg freezing and underwent three rounds of it with Zhang five years ago. (He had a package deal then.) I can tell you the mood swings of clomiphene citrate are no picnic. Also, while one study showed that eggs coaxed out through minimal stimulation are less likely to create chromosomally abnormal embryos than those from a bumper harvest, mainstream fertility doctors insist that the traditional protocol results in more normal embryos overall and hence higher pregnancy rates.
Minimal stimulation represents a valuable alternative to the traditional drug protocol, and more clinics should consider offering it. Its lower price makes it accessible for younger women to at least bank some eggs now, rather than wait until the last minute when they’re in their late 30s and early 40s. It’s also an important example of how a seemingly inflexible fertility industry can offer women more choices. In fact, many doctors who offer traditional egg freezing are also exploring different pricing models. As egg freezing becomes more popular, increased competition among doctors has brought down prices as low as $4,000 to $5,000 for traditional cycles in many cities.
Perhaps the most revolutionary development is yet to come. Several clinics are working out the kinks for programs that would allow women who donate eggs for other patients to keep and freeze half for themselves. The option would only be available for donors under 32 who pass physical and psychological screenings, but it opens the door for younger freezers who might not otherwise have a way to pay for the procedure.
Of course, women should do their research and be wary of doctors with too-good-to-be-true deals who lack a track record of frozen-egg babies. Yet these shifts in the marketplace are encouraging and hopefully will lead to more innovative thinking that gives women the chance to save some of their best eggs when they’re at their prime.