Is a procedure that allows a woman to preserve her eggs all it's cracked up to be?
It's no secret that a woman's eggs age, just like the rest of her body. It's a message that's been driven home by the media's fear-mongering and our collective cultural obsession with aging (particularly of women). In the past, a professional woman who chose to spend her "fertile" years pursuing a career had few options: enlist an egg donor, adopt a child from a faraway country, or try and try again, hoping against odds for a healthy pregnancy.
But now there's another choice: A woman can actually freeze her eggsfor later use. In the works since the early '80s, this procedure—which extracts and preserves a young woman's eggs for use up to 10 years down the line—is now becoming widely available through a private group called Extend Fertility. Last month in California, Extend opened its first in a soon-to-go-national chain of clinics for the cryopreservation of oocytes—in other words, egg freezing. Founded by entrepreneur (and three-time Forbes cover girl) Christy Jones, Extend is drawing on the resources and specialists of the Huntington Reproductive Center in Pasadena and the Texas Fertility Center in Austin, and plans to work with six more existing fertility centers by the year's end. Jones, who is 34, envisions her primary target group as professional women under age 35—women on the fast track in fields like finance and law whose careers would be picking up steam just as their reproductive systems are slowing down.
While egg freezing has long been considered experimental—and will still be classified as such by the American Society for Reproductive Medicine in their forthcoming guidelines—many doctors are now confident in the future of the procedure. This is thanks to an ever-improving understanding of the physiology of women's eggs: Now, for instance, doctors dehydrate the egg before freezing it, preventing harmful ice crystals from forming and piercing the shell. The success rate of egg freezing has thus become comparable to that of in vitro fertilization—about 25 percent, a significant rise from only a few percentage points just three years ago. (Extend is careful to inform potential clients that the procedure does not come with a guarantee.) But even in light of these optimistic figures, the question arises: Is egg freezing the solution women have been waiting for, or merely a false hope from modern science?
First, let's look at how the procedure works. A woman, typically age 35 or under (fertility peaks around 27), is determined healthy enough for the procedure through blood tests and an ultrasound. She then self-administers hormone injections over the course of 10 days to prep her body to produce up to 20 eggs that month, with minimal side effects (some cramping and bloating). Next, through a quick, noninvasive procedure at an Extend clinic, the eggs are "harvested" from the follicles using a long egg-retrieving needle. Once gathered, the tiny cargo is loaded into holding tanks filled with liquid nitrogen, bar coded with a client-specific number, and finally driven to a storage facility where it can be kept safely for over a decade. When the woman is ready to become pregnant, the eggs are thawed, mixed with a partner's sperm, and the embryos implanted inside her. Voilà: Freedom of choice!
On one level, the procedure is nothing new: For two decades, we have lived in a brave new reproductive world in which, thanks to the weird wonders of IVF, sperm and eggs can be reordered like pieces in a complicated puzzle. For women, the tug of war between our biology and our professional lives has become like cultural white noise: Jokes about "turkey basters" pepper our sitcoms, and ads seeking egg donors—"$7,500 compensation!"—appear before trailers at the movies. It's not hard to understand why: 20 percent of American women now postpone pregnancy until after age 35, when the decline of fertility becomes significant. By 40, a woman's chance of having a successful pregnancy nosedives from about 30 percent to 10 percent; by 42 to a scary 5 percent. In addition, by age 40, a woman has 10 times the chance of her baby developing chromosomal abnormalities. Given such statistics, it's clear why "assisted reproductive technology" has grown into a billion-dollar industry with more than 100,000 women a year undergoing IVF.
In a culture obsessed with fighting off the purported horrors of aging—think Botox, neck-lifts, anticellulite creams—the ability to freeze one's eggs gives women a completely new level of control over their bodies by essentially removing age from the baby equation. It's possible that the option could bring about a revolution in reproductive choice on a par with the introduction of the birth-control pill or the legalization of abortion. Think about it: Egg freezing fights off the persistent ticking of the biological clock, and with it the cliché of the desperate, thirtysomething single woman cruising for the perfect mate.
Still, it's a bit like The Handmaid's Tale—after all, we're talking about reproductive freedom of choice for some. The cost of cryopreservation renders it, like IVF, a luxury limited to the top of the socioeconomic ladder: One session runs as high as $12,500 to $14,000, and many women opt for two or three sessions. (It's no secret that many IVF egg donors are students strapped for cash.) Extend's Web site, Extendfertility.com, clearly caters to a specific crowd; it features photos of thirtysomethings in bobs and Ann Taylor blouses with accompanying text that describes women "obtaining advanced degrees, pursuing successful careers." These are the super-achievers ready to meet the Extend challenge to "set your own biological clock."
And while this newfound control may purport to allay fears of waning fertility, it may also provoke new anxieties for women still in their 20s. For the procedure to work, specialists recommend a woman freeze before age 35—and preferably by age 30. If freezing becomes a more widely accepted option, twentysomethings may start planning ahead for the procedure, viewing it as a kind of insurance. (What if I don't meet the right guy? What if I'm on the way to making partner?) The post-college pressure of getting on the right career track will be augmented by the pressures of getting on the right biological track. And at the very moment when she's finally paid off her school loan, a young woman will be saddled with yet another unavoidable expense.
In addition, egg freezing may bring with it a whole new level of scrutiny of women's bodies (as if that were possible). A recent article in Elle magazine quoted a doctor in the field describing older women's eggs as "dark and grainier" compared to the "brilliant" and "beautiful" eggs of younger women—it's as though the culture's rigorous standards of beauty should extend even to our ovaries. Indeed, this new dialogue creates the impression that women are not only wrinkling on the outside, but on the inside as well.
Yet there are real differences between the bodies of younger and older first-time mothers that should be taken into account: For example, older women are more likely to develop diabetes, high blood pressure, or cardiovascular disease during pregnancy. Plus, a real, unspoken question remains: What woman, given a choice, truly wants to become a mother in her mid-to-late 40s? To run after a preschooler in her 50s? And certainly our culture would need to adjust to an upsurge in graying mothers: To look at the average sitcom or greeting card, it appears we still take great comfort in the illusion of the young and rosy new mom. Finally, couldn't the very steps taken to help a woman achieve her professional goals createa new set of career tensions? A middle-aged mother would be taking an extended sabbatical in her 50s just as her male peers are coming of CEO age.
Doom and gloom aside, egg freezing is an incredible breakthrough, a significant new option to add to our short list of reproductive choices. But this medical marvel obscures a greater issue: the need for social change. Whatever happened to talk of improving childcare for working parents? Whatever happened to the idea that pregnancy and child-rearing are more than some kind of extended sick leave? The idea that children could and should be an integral part of the lives of even the most competitive professionals—whether male or female? The responsibility for making up for the inequities that exist in our culture should not be placed solely on the shoulders of women, regardless of whether or not they can afford a trip to one of Jones' clinics.
There are the real issues at stake. And we can't look to science to cure them.
Alex Mar is a writer/director whose work has also appeared in New York magazine and Rolling Stone. Her first film, the documentary American Mystic, will be released this year.
Illustration by Robert Neubecker.