Real Talk, Should You Actually Freeze Your Eggs?
Tags: Womens Health, Ivf, Women, Fertility, Parenting

By Vicky Spratt

PHOTOGRAPHED BY DAANTJE BONS

When she was 32 years old, Ali, a marketing manager based in the southeast of England, broke up with her boyfriend of six years. “There was a nagging feeling in the back of my mind that the clock was ticking and I was worried about how much time I would have left to meet the right person and start a family,” she reflects today, at the age of 35. Her words will strike a deep, primal and emotional chord in any woman, single or not. For the relationship we are all in, whether we like it or not, is with our own fertility.

One year after this break-up, knowing that both her mother and grandmother had experienced menopause at an unusually early age, Ali decided to freeze her eggs at a clinic in Maidenhead. It cost her £5,000 in total. She had been saving for three months and then was made redundant, which she describes as “a blessing in disguise” because she got a new job really quickly and was able to put her payout towards the procedure.

Ali, who is now in a new relationship, thinks that freezing her eggs has changed the course of her life. “If I hadn’t,” she says pointedly, “my fertility may have pushed me to have a family with someone who wasn’t right, instead of getting out of that relationship. Knowing that my eggs are frozen removes some of the immediate pressure and makes you feel more in control of your future. You’ve done all you can, and there’s something very reassuring about that.”

Egg freezing is an intensive procedure which involves injecting yourself with hormones for about 10 days before an operation which is done under anaesthetic to harvest the eggs. During a normal ovulation cycle, a woman produces one egg. The hormones administered in this process stimulate the ovaries so that they produce multiple eggs. The NHS only offers it to girls and women for medical reasons (e.g. if someone is about to undergo an operation or treatment that could make them infertile, such as chemotherapy).

Recent data from the Human Fertilisation & Embryology Authority (HFEA) shows that the number of egg storage cycles has increased rapidly, rising from 1,500 cycles in 2013 to just under 9,000 in 2018.

If you want to freeze your eggs because you aren’t in a relationship or ready to have children, you have to pay to go private. Some people call this egg freezing for ‘social’ reasons. However Lisa Webber, consultant gynaecologist and subspecialist in reproductive medicine at St Mary’s Hospital Imperial College Healthcare NHS Trust, explains that she prefers to call this ‘non-medical’ or ‘elective’ egg freezing. It has been rising steadily in recent years, as Professor Adam Balen, a consultant in reproductive medicine at Leeds Teaching Hospitals NHS Trust and spokesperson for the Royal College of Obstetricians and Gynaecologists (RCOG), explains. “Recent data from the Human Fertilisation & Embryology Authority (HFEA) shows that the number of egg storage cycles has increased rapidly, rising from 1,500 cycles in 2013 to just under 9,000 in 2018.” This is a staggering increase of 523% which means that the number of women freezing their eggs has increased five-fold.

It’s not hard to understand why this is happening. On a recent girls’ holiday, whether or not to embark on egg freezing was a daily topic of conversation. All five of us on the trip were in our early 30s, working full pelt in our careers and, regardless of relationship status, neither financially nor emotionally ready to start a family. This trend is seen across the country: the Office for National Statistics reports that the average age at which both women and men have their first child has increased in recent decades. There are many explanations for this. We have contraception which gives us reproductive autonomy, women are now entering higher education and the workforce in record numbers and, generally, we settle down later than ever before which can be explained, at least in part, by the fact that record numbers of young people live with their parents for longer because the cost of living, specifically housing, has risen dramatically beyond wages over the last decade or so. Within this socioeconomic context, egg freezing has become the zeitgeist because while adulthood may look different for young people, the fertility of both men and women still declines with age. This has led to some employers, particularly future-facing tech companies like Google, Facebook and Apple, offering their female employees the procedure as a ‘perk’. Pre-pandemic, you could even go to an ‘egg-freezing party’ at some clinics in the UK and the US.

According to Adam, the average cost of egg freezing is £3,500, with medication an extra £700-£2,000. In addition, there is a yearly cost of £125 and £350 for storage of the eggs (about £350-£500). Thawing eggs and transferring them to the womb costs an average of £2,500. In total, therefore, the whole process for egg freezing and thawing costs an average of £7,000-£9,000.

For women who can afford to pay — like Ali — or who stretch themselves to find the cash — like 36-year-old NHS nurse Ruth, who recently went through the process — harnessing medical technology to put some eggs on ice feels like a way of taking power back into their own hands. “It just feels like an expensive insurance policy,” she explains over the phone after a 12-hour shift. “I feel better now that it’s done although my overarching feeling is that I wish I had done it sooner because then maybe they would have been able to harvest more than five eggs.” Ruth was incredibly disappointed to only get five eggs in her harvest but can’t afford to have another go.

I regularly hear young women refer to egg freezing as ‘insurance’ but a panacea to our biology and gender-based economic inequality this is not. “The word insurance really is the wrong word,” Lisa explains, “because insurance policies pay out and you know the circumstances under which they’re going to pay out. I encourage people who are thinking about egg freezing to think about it in terms of giving yourself an opportunity. It’s not an insurance policy because the data shows that there is definitely no guarantee of success.” She adds that she is rigorous with any woman who comes to her while they are considering freezing their eggs and reinforces that it offers no guarantee of having a child.

Lisa then talks me through the data. There is an average 70–80% chance that frozen eggs survive the thawing process, the chance being higher when women are younger than age 35 compared to older. She notes that age is also a factor in the success rate should frozen eggs survive the thawing process. The chance of having a live birth from frozen eggs is directly related to how old a woman is when they are harvested. Excluding pregnancies arising from any additional embryos that have been created from the batch of eggs, at under 35 years old it is estimated to be 28%, at between 35 and 37 it is 23.5%, at between 38 and 39 it is 18%, at between 40 and 42 it is 11% and at between 43 and 44 it is 4%.

The total chance of a live birth from any batch of eggs also depends on both the number of eggs collected and the number of embryos created: that is called the cumulative live birth rate. So a woman under the age of 35 who has 10 eggs collected will have a 60–70% chance of a live birth as she may undergo more than one embryo transfer cycle. However, the same number of eggs in a woman aged over 35 will have a 30% chance of having a baby.

Another huge problem, Lisa notes, is the data itself. Published statistics often refer to eggs that were frozen years ago, before the freezing technology improved. Since then, many thousands of eggs have been frozen which are yet to be used and so published statistics aren’t available yet. “The way eggs are frozen can differ,” Lisa explains. “They used to be frozen through a process called slow freezing and now most clinics use vitrification. So, when data was collected and what sort of methods were used in egg freezing impacts its reliability.” HFEA has confirmed that it is going to review the data and look at how best to update it because the use of egg freezing is increasing and success rates are improving.

The average cost of egg freezing is £3,500, with medication an additional £700-£2,000.

The question women often ask themselves, their friends and medical professionals is what, if any, is the ideal age to freeze your eggs. Lisa notes that the younger you are, the better but adds that, of course, many women can’t afford to do this in their 20s and the younger you are, the higher your chances of meeting a partner and having a baby naturally. The UK also currently has a 10-year limit on frozen eggs so, for instance, if you went through this at 22, your eggs would only be available until you were 32. RCOG is calling for this limit to be extended to provide women with more choice but, right now, that is just how it is.

Surely, then, there are ethical questions to be asked about private clinics profiting from women’s biology. There is no official figure for how much this industry is worth in the UK but with women paying thousands of pounds for one cycle of treatment at a minimum, it’s fair to say that it’s a lucrative business.

Adam says: “While some specialists are suggesting that if a woman hasn’t had a baby by the age of 37 she should have her eggs frozen, this is a step too far and women need to be clear on the possible outcomes — as the technology doesn’t guarantee a baby and requires a woman to go through a cycle of IVF which is no small undertaking.”

Julia, a 33-year-old graphic designer, recently had reasonable success during her egg freezing harvest which, like Ali, she decided to embark upon one year after ending a significant long-term relationship. She paid £5,000 and they managed to get 10 eggs suitable for freezing. Yet she is all too aware of this double-edged sword. “I feel like this was less about paying for my fertility and more about paying for my peace of mind,” she explains. “I know that freezing your eggs is no guarantee that you will have a baby in the future but it does make me feel more confident. I think that’s something that all women should have access to: fertility MOT screenings on the NHS every year, like you would with a normal medical check-up. Women’s fertility is so mystified and so many women in their 20s and 30s have no idea until they start trying to conceive, by which point it might be too late. I feel empowered knowing what my situation is.”

Therein lies the rub. I don’t know about you but I rarely hear men say “I wasted years with…” after a break-up. Yet men’s fertility declines with age too. No matter how far we progress, women are still haunted by an invisible but inescapable so-called ticking biological clock which hangs over us like the sword of Damocles whenever we make a relationship or career decision. Men are implicated in this discussion too but somehow we’re generally the only ones having it. It can be no surprise that more than one person has spotted a business opportunity in that and that growing numbers of women who want to feel they have agency, autonomy and, above all, options, are prepared to pay if it makes them feel that they can buy themselves time.

Janet Lindsay, chief executive at women’s health research charity Wellbeing of Women, perhaps puts it best. “We support a woman’s decision to take control of her reproductive health and safeguard her fertility where possible, but it is important to recognise that ‘non-medical’ egg freezing is not the ‘insurance policy’ it is sometimes proclaimed to be. Social egg freezing must not be seen as society’s silver bullet for what is a natural decline in fertility over a woman’s lifespan.”