Egg Freezing: No longer taboo, but still a mystery to many (and it shouldn’t be)
by Lola Banjo
A s your Facebook newsfeed fills with baby announcements and pictures, it’s easy to assume that getting pregnant naturally is simple. But achieving pregnancy with ART (Assisted Reproductive Technology) is more common than we think.
According to a 2015 report by the U.S. Society of Assisted Reproductive Technology, 1 million babies born in the U.S. between 1987 and 2015 were born through the use of IVF, an egg donor or a sperm donor. A common misconception is that only women over a certain age use IVF, but women of all ages struggle with fertility challenges. Conditions such as PCOS, endometriosis or fibroids could cause some women to be unable to get pregnant naturally or be unable to carry to term.
Egg freezing, while relatively new, has opened up avenues for women to explore prolonging their fertility, but there is still limited knowledge about the process. A recent study conducted with a cross section of reproductive age women reported that “overall, 87.2% reported awareness of egg freezing, yet only 29.8% knew what it really entails.” In addition, for many women, egg freezing can be a cost-prohibitive process, making it inaccessible to certain demographics. A recent report found that only 4% of respondents who froze their eggs were African American, 4% Hispanic and 1% Middle Eastern.
Our biological clock
A girl is born with all the eggs she will ever have, approximately two million of them. By the time she begins menstruating, she will have about 400,000 remaining, and from then, about 1,000 die each month. On average, she will have approximately 12% of her reserve at age 30 and only 3% at age 40. This decline continues until she reaches menopause at an average age of 51.
Technically, a woman can naturally conceive till she reaches menopause, but it becomes harder with time. From ages 30–34, a healthy woman trying to get pregnant naturally has about an 86% chance of conceiving in a year and those odds decrease slightly to 78% from ages 35–39. By the time she is well into her 40s, 90% of her eggs will be chromosomally abnormal, making it harder to conceive and increasing her risk of a miscarriage, a Down syndrome pregnancy or an abnormal pregnancy.
What egg freezing attempts to do is freeze time — that is, keep a woman’s eggs at a certain point in time when they were of higher quality. For example, if a 45-year-old woman were trying to conceive, typically, she is better served using the higher quality eggs she froze while at age 35.
The social stigma
In many minority communities, matters regarding fertility and reproductive health are considered highly personal and people are less open about their experiences, sometimes even with other family members. The stigma often makes women who have undergone any kind of ART ashamed or afraid to talk about it in fear of being judged. But seeking out these techniques, whether for social or health reasons, does not mean a woman has been any less careful about her fertility or that there is something “wrong” with her, it just means she is aware of all the options that science has created to make it possible to have a chance of becoming a mother.
While my reason for freezing my eggs was a social one, the pervasiveness of the stigma meant that when I was researching the process, it was hard to find women within my social sphere who had been open about freezing their eggs or were willing to discuss their experience. This hesitation to share can often feel isolating as we are unaware that there are many other women experiencing similar things. Michelle Obama recently alluded to this in her book where she discusses her IVF journey and having a miscarriage. She recalls feeling like a failure, ashamed and lonely, until she realized she was not alone.
My personal journey
From a young age, having children has been one of my greatest life goals. While many girls dream of their wedding day, I’d fast forward to becoming a mother. I’ve even had the names of my future kids picked out since I was in high school. However, juxtaposing my dreams of motherhood against being somewhat traditional yet progressive meant this dream would have to wait until I was in a great place in my career, had secured financial independence, and had a suitable partner to raise children with, a scenario familiar to many ambitious family-oriented women.
At 28, it seemed I had it all. I had just graduated from a top MBA program, started my post-MBA career at a top Management Consulting firm, and was newly engaged to who I thought was the love of my life. Life was perfect, until it wasn’t. Everything came crashing when my relationship ended. Before this, the plan was to have my first kid at 30 shortly after we were married, the second at 32, and the third at 34. Instead, I was so devastated that I swore off relationships for the next three years to protect myself from another heartbreak. I spent the time focused on my career and traveling the world.
When I came out of my three-year dating hiatus, I had a moment of panic. The societal pressures of getting married had started to get to me, and I could no longer ward off the not so gentle nudges from my family that I was getting older. Though I was thriving in other aspects, I felt like I was failing in life because I was nowhere close to being married and having children. During this time, I began to put a lot of pressure on myself to make it work with whomever I was seeing because “time was ticking”. It became an up and down rollercoaster of finally liking someone, emotionally investing in them, then realizing we were not a great match and having to go back to the drawing board. I no longer enjoyed dating — it felt more like a draining task with a rabid sense of urgency. I’d wonder if every guy sitting across the table from me on a date could potentially become my husband/the father of my children.
But as strongly as I want to be a mother, I am also a hopeful romantic who believes in love and finding “the one” and I was not going to compromise on that. I knew I had to reset and get back to my normal self. I wanted to date (and have fun doing so), take the time to properly get to know someone and let the relationship blossom without the pressure of stressing about the future.
Yet, knowing that my fertility doesn’t depend on the pace I want to take things in my relationships, when my ob-gyn reminded me during my last annual that I needed to stop procrastinating on freezing my eggs, I knew she was right and in July, I started the process.
My story is not uncommon. Once a woman reaches her 30s and is unmarried without children, she is aware of how society may negatively view her and will find herself fielding questions about her status both directly and indirectly. This pressure can adversely affect even the most free-thinking and strong-minded of women. A woman who has had a major failed relationship during that time might find herself especially stressed. Because of the fear of starting over, women in their 30s and 40s are less likely to leave bad relationships and more likely to overlook fundamental flaws in a partner than they would have in their 20s. Instead, we convince ourselves to stay when we should leave, that we’re happy when we’re not, or that we are asking for too much in a relationship when we are barely asking for enough. Unfortunately, this likely leads to more unhappiness, regret and/or divorce.
While freezing our eggs doesn’t entirely alleviate all concerns, it can help to take some of the pressure and stress off as we continue to strive for excellence in our lives and seek a loving relationship with a caring and supportive partner to start a family with.
Things to know about egg freezing
More than likely, you’ve heard of egg freezing being mentioned casually, but many do not know what it really entails. First, here are some common terms to know:
- Oocytes: The scientific name for an immature egg cell
- Anti-Müllerian hormone (AMH) level: Predicts the ovarian reserve — i.e. egg quantity. A higher number could indicate a stronger ovarian reserve
- Follicle-stimulating hormone (FSH) level: Used to measure the quality of remaining eggs. A lower number could indicate higher quality eggs
- Hysterosalpingogram (HSG) test: Checks for blockage of fallopian tubes
- Antral Follicle Count: Used to count the number of follicles in the ovaries. Generally, each follicle contains an egg, hence, typically, the more, the better
- Cryopreservation: The process through which the eggs are frozen
Having just completed my retrieval, here are some things I learned about the process:
Freezing your eggs does not guarantee a baby. While the success rate has been improving, outcomes will vary depending on age, genetics, reproductive history, and other lifestyle factors.
The initial tests are very important. After your initial consultation, you will go through robust testing of your fertility factors, reproductive health, STI status and genetics (if selected). You should not make assumptions about your fertility prospects until you learn what your numbers, such as your AMH and FSH levels, are. The results will help your doctor assess if you should continue with the process, and if so, which medications you will need. I opted for the full panel of tests including genetic testing and in doing so, I learned more about my body than I ever thought possible. It felt like I was tested for every disease and genetic condition imaginable, most I had never heard of.
Freezing your eggs does not deplete your egg supply. Your normal reproductive cycle won’t be affected because only the eggs that will be “lost” anyway through the natural process will be captured. You will continue to have your cycle as normal.
Do it when you feel most comfortable, but the earlier the better. On average, 25-year-old eggs are “better” than 30-year-old eggs and 30-year-old eggs are better than 35-year-old eggs, etc. If you’re wondering when is the best time to freeze your eggs, the general rule is now.
Egg retrieval is the first part of IVF. In a full IVF cycle, after the oocytes are retrieved, sperm is used to create an embryo in vitro, and then the embryo is implanted. If you freeze your eggs, when you are ready to use them, you will conclude the second half of the IVF process.
It is not a quick process. Durations vary, but it took about three months from the time I had my initial tests to the time I had the retrieval surgery. While the injections themselves last 10–12 days, some tests leading up to it can only be done at certain times of the month.
Injections, injections, injections. I almost changed my mind when I realized how many needles were involved because I am terrified of them. Brace yourselves, there’s a lot. There are frequent to daily blood draws to test hormone levels and then every night, I injected myself three times in my abdomen between 8–10pm for 11 days.
You cannot travel for a period of time. Throughout the three months, I was only able to squeeze in a week of work travel. As someone who loves to travel, my inability to do so felt suffocating. You have to visit the clinic frequently for blood tests and ultrasounds, hence the travel restriction.
Not everyone in your life will understand your decision. If you are looking for unanimous support from family and friends, you might not get it. Some people may question your decision or advise you to just “focus on finding a man instead”. Expending your energy on trying to convince someone it is a good idea to freeze your eggs might be spending it on the wrong thing. As long as you (and your doctor) know why you’re doing it, that’s good enough.
That said, you will need support. If you’re a single, independent woman, you might be inclined to think you can do this entirely on your own, but this can be a lot and it helps to have a support system, no matter how small. I was blessed to have the support of a couple of loved ones and having them to talk to was invaluable. A great example was my best friend FaceTiming with me as I administered the injections the first day. I had called her in tears seriously doubting if I could do it, but she calmly cheered me on.
Even with support, the process will often feel long, lonely and emotional. There is loneliness in the mere act of pricking yourself with needles every night and clinic visits every morning before the rooster crows. But also, due to the hormone injections, my estrogen level was incredibly high and I was very emotional. I felt proud about freezing my eggs but I also felt some sadness about having to do it at all. I’d cry when I’d see a baby, even staying off social media to avoid it. My normal routine was also completely thrown off track; one particular tough morning, I got up at 4:30am to get to the clinic by 6am, but it was so packed that I was not seen till 7:30am, and I had an important 8am meeting with a 1hr+ commute. I was so overwhelmed that as soon as I stepped into my car, I burst into tears. My weight was also out of control and I lost all the definition in my abs as my ovaries expanded. I had no desire to be social — I wanted to just stay home all day. But don’t worry: this part only lasts for a few mentally and physically exhausting weeks.
The egg retrieval is a surgical procedure. On your retrieval day, you will arrive at the clinic, be hooked into an IV, then proceed to the operating room. A propofol-based anesthesia will be used to knock you out. Then the surgeon uses an ultrasound probe through your vagina to retrieve the eggs. You don’t feel a thing. The surgery takes less than 30 minutes, but plan to be there for three hours. You must have someone accompany you as you will not be able to drive yourself home.
Give yourself time to recover. Bravo, you made it! But your body just went through a lot. Take time off work if you need to and rest. It takes about a month for you to feel fully back to normal again. After my surgery, I was still very bloated and had days of painful cramping. I was also nine pounds heavier, due to both the IV fluids and not being able to work out for weeks. You are advised to refrain from working out (or sex) for another 1–2 weeks.
The number of eggs retrieved per cycle will vary by person, and is unpredictable. During each ultrasound, the number of follicles in the ovaries are counted. Generally, the more follicles the better, but not every follicle might contain an egg. In addition, some of the retrieved eggs might not be mature enough to be frozen (every egg starts out immature — the medications help accelerate maturity but not all mature). For example, I was initially disappointed that close to half of my retrieved eggs were not mature, but I learned this is normal.
You may need multiple cycles. Doctors advise freezing 6–10 eggs per live birth desired because when you are ready to use your eggs, some eggs may not survive thawing and some will not successfully fertilize into an embryo. Multiply this range by the number of kids you may want to have (e.g. 12–20 eggs for two). You will likely be unable to know if you will need more than one cycle until your first cycle is complete.
Every woman will have a different experience. While it is good to share experiences, be careful comparing. Our bodies are different. Two seemingly identical women could have drastically different experiences and results due to factors beyond their control.
As women continue to strive towards full equity in every regard, and as the average marrying age increases, the rate of women choosing to freeze their eggs also continues to increase.
In the past, egg freezing was thought to be a thing that women did so they may focus on their careers, but that is changing. A recent study found that 85% of women surveyed who had frozen their eggs said they did it because they did not yet have a person with whom to raise a family with.
When I’m ready to start a family, I hope to conceive naturally but having my frozen eggs just in case makes me feel relieved, empowered and less pressured in my dating.
If you’re also considering freezing your eggs, I commend you on making this important decision. What you are about to embark on won’t be easy, but if all works well, it will be worth it. Though you might feel overwhelmed, you are not alone. You are strong and amazing — you can do it!
I put this guide together because it is what I wish I had available to me. I hope you found it useful. If so, please stay tuned for Part 2: “Thinking of freezing your eggs? Here’s how you can afford it”.
Lola Banjo is a corporate strategist and innovation executive with a passion for advancing women and underrepresented minorities. She has spent the majority of her career helping large organizations achieve strategic goals through a blend of analysis, partnering and creative problem solving and she uses the same thinking to ideate on tangible ways to address social issues. Her personal passion for and commitment to serving others has led her to her work as Board Director at Mouse.org, an organization that supports youth from underserved demographics via a technology education, and as a committee member of FACE Africa, an organization addressing water and sanitation issues in subsaharan Africa. She holds a B.S. in Materials Engineering w/ minors in Mathematics, Economics and Computer Science from Rutgers University, a M.S. in Financial Engineering and a Grad Certificate in Risk Management from New York University, and a MBA in Strategy, Finance and Decision Sciences from Emory University. She has also studied at top schools around the world including FGV Rio (Brazil), WHU Koblenz (Germany), RSM Erasmus (Netherlands), The London School of Economics and SDA Bocconi (Italy). She is an avid photographer and world traveler, having visited 100+ countries and counting.
