The Pill of the New Millennium?

posted by Brigitte Adams February 17, 2017
Egg Freezing: Decade in Review

The State of Egg Freezing: A Decade in Review

Olivia Munn, Sofia Vergara and Kim Kardashian have done it.  The Mindy Project featured it in season four.  Google keyword searches have increased 900% since 2012.  Even tech darlings, Apple and Facebook, have jumped on the bandwagon offering it as a health benefit for female employees.

Egg freezing is now part of our vernacular.

Often referred to as the birth control pill of the new millennium, egg freezing, originally developed for cancer patients, is becoming increasingly mainstream.  No longer relegated to hushed corridors of fertility clinics, the fertility preservation discussion now holds court in blogs, bookclubs and boardrooms. 

Mindy Kaling Egg Freezing
Your body and your eggs just keep getting older, which is whyfreezing them is actually a pretty smart idea, because it gives you a little more time so that you can try to find that one diamond in the crap heap of American men.

In the five short years since I froze my eggs, egg freezing has moved from an “experimental” procedure to dinner party fodder. Women from New York to San Francisco are juggling cheap glasses of chardonnay and egg timers emblazoned with fertility clinic logos at egg freezing happy hours.  You Tube videos document women’s intimate personal journeys from the dreaded first hormone shot to final retrieval day. Urging greater fertility awareness, Op ed pieces are pleading women “to talk about our eggs.” Parents are urging their single daughters to freeze and often chip in to pay for the pricey treatment.  Progressive tech companies, law firms and banks are adding egg freezing to their insurance riders.  Excited by the expansive addressable market, entrepreneurs are hungrily entering the nascent fertility preservation space.

Our Eggs Have Not Adjusted to Today’s Reality

Once upon a time a woman married in her early twenties, quit her job and had 2.5 children. Fast forward a generation and we are getting married later and later and postponing pregnancy even longer.  In fact, in the U.S. first births to women aged 35 and over increased 23% since 2000. Our biological clocks, however, are still set at our mother’s generation. Completing a higher education, climbing the corporate ladder, meeting a mate and building a nest egg all take time.  Our eggs unfortunately have not adjusted to today’s reality.

age-impacts-fertility

However, like so many women-centric topics, it is a polarizing issue that is being picked apart from every  angle.  Egg freezers are often described as selfish workhorses more intent on climbing the corporate ladder than procreating.  Or, freezers are labeled as unrealistic procrastinators desperately holding out for the elusive Mr. Right instead of Mr. Right Now. Others claim that egg freezing shackles women to their corporate desks effectively derailing much needed workplace reforms. 

Please! 

If anything, the fertility discussion is highlighting our draconian family leave and maternity policies.  Fertility preservation provides women with time, flexibility and options in a world where having it all is becoming increasingly untenable.

A Possibility Not a Guarantee

As an early adopter and a vocal egg freezing advocate, I have followed the egg freezing evolution first hand.  I am pleased that the keen media attention has pushed more and more women to take ownership of their fertility.  Not only are we better informed about our finite fertility window (the now ubiquitous chart of the ovarian reserve inflection point is imprinted on the minds, and more often nightmares, of most women over 35), we are also proactively navigating discussions at the gynecologist office from contraception to fertility testing.  We also know more about egg quality and realize that the Hollywood celebrity did not get pregnant naturally (wink, wink) at 49. And, more women like myself, are climbing onto the egg freezing soapbox to share our stories so our younger counterparts are better informed and empowered than our generation. 

Although I am pleased that fertility awareness is finally being openly discussed, I am concerned that egg freezing is being pitched as a silver bullet.  Freezing does not equal a baby, but a POSSIBILITY of a future child.  I truly hope that this distinction does not get lost in the race to commoditize egg freezing.

Egg Freezing Milestones: From Experimental to New Normal

From improved egg freezing techniques, falling prices to VC backed new businesses, egg freezing’s rise in adoption and media traction can be traced to a few key milestones over the past decade.  Given the rapid transition from experimental to new normal, the future of egg freezing is fertile ground for debate.

2005: Vitrification Revolutionizes Egg Freezing

Egg freezing, or oocyte cryopreservation, is not exactly a new technology, in fact the first child conceived from a frozen egg using the slow freeze method was born in 1986. Slow freezing, however, was fraught with problems. Because delicate human eggs have a very high water content level freezing them without causing destructive ice crystal formations was tricky.

Everything changed with the advent of vitrification, a new fast freezing technique.  First reported with a human egg in 2000, but not replicated until 2004, vitrification changed the course of fertility preservation.  Vitrification, meaning to turn to glass, quickly dehydrates eggs in a series of cryoprotectant solutions prior to plunging them into -320º Fahrenheit liquid nitrogen tanks.   By 2005, Japan and Italy reported several cases of babies born via vitrified eggs and by 2006 major US fertility clinics were launching successful pilot studies.

Vitrification revolutionized the egg freezing landscape.  Now the de facto egg freezing method employed by clinics across the globe vitrification made the ability to pause the biological clock a new reality.

2012: Egg Freezing Experimental Label Lifted

Early egg freezing adopters encouraged by the improved success rates of vitrification steadily increased in number.  However, women like myself, in this early cohort group heard about egg freezing via the infertility grapevine often from women a few years our senior who had endured multiple failed rounds of IVF.   Egg freezing articles surfaced here and there, but the topic was still far from the front page of the New York Times.

Things changed in October 2012 when The American Society for Reproductive Medicine (ASRM) removed egg freezing’s “experimental” label. After reviewing more than 1,00 studies, the ASRM reached the conclusion that:

    1. Frozen and thawed oocytes (eggs) are as effective as fresh eggs commonly used in IVF
    2. Frozen eggs do not increase the risk of birth defects or chromosomal abnormalities

Although the scientific merits of egg freezing had already been validated, the ASRM’s decision to legitimize egg freezing made it more accessible to both clinics and patients.  While the experimental label was in place, many clinics implemented institutional review boards and required patients to sign “experimental consents.”  Also, many women anxious about undergoing an experimental procedure often delayed or even opted against freezing all together.  With the logistical layer and psychological barrier removed, egg freezing is now a truly marketable fertility preservation technique.

2014: Corporate Coverage

Two years to the month of ASRM’s experimental label removal, the egg freezing discussion took another turn. In the fall of 2014, Facebook and Apple announced full coverage of egg freezing for non-medical reasons.  This new “perk” clogged the news cycles and fundamentally shifted – and divided –  the egg freezing discussion. 

Proponents lauded the move as a pragmatic step to give working women more options to balance career and motherhood.  The opposition, however, viewed egg freezing coverage as yet another set back for equality in the workplace. 

Corporate shackle or savior, Apple and Facebook’s announcement raised a variety of professional, social and ethical questions.  It was also a tipping point.  Egg freezing now had a new demographic of younger working women and unlike most early egg freezing adopters who often felt like they had somehow failed, instead viewed freezing their eggs as a proactive, empowering option. 

2016: Declining Costs & New Business Models

In the last decade, the face and business of egg freezing has changed. Clinics are getting savvier about egg freezers. Clinics have finally realized that that the demographics and goals of egg freezers are very different from IVFers.  Pictures of bouncy babies in marketing collateral have been replacing with confident corporate co-eds.Egg freezers are looking to the future while IVF patients are laser focused on the present.

Like any new technology, prices have dropped significantly over the past five years.  Eager to capture this growing market, entrepreneurs are jumping onto the egg freezing bandwagon.  New business models and pricing schemes are starting to emerge.  Instead of an up front cost of $10,000 or more, companies are experimenting with $199 monthly installment plans.  Designed for busy working women, egg freezing concierge services are proliferating. 

What will happen to the egg freezing marketplace in the next decade?  Costs may continue to fall and speciality clinics will grow and more women will come back to use their frozen eggs.  Time will tell if these women will reach their goal of motherhood with their frozen eggs or need to look to plan B.

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