Egg Freezing On The Company Dime, Ctd

A personal story from the in-tray adds some critical context:

I have read this conversation with some interest, because it is all too close to home. Tomorrow, my wife and I are transferring a frozen embryo after a fresh transfer failed in late August. For these reasons, I have become all too conversant on the subject matter … yet it is a conversation that one rarely has beyond our own home. (I will note that my wife and I are very lucky in that we both have extremely generous coverage and a non-trivial cache of frozen embryos to work from; it is unlikely that we will have to ever do another egg retrieval.)

I think the piece you quoted by Pamela Mahoney Tsingdinos, along with your reader, needs to be placed in a bit more perspective. In Tsigdinos’ case, I suspect the experience she has had (which I can completely empathize with, as fertility treatment is emotionally exhausting) has led to a somewhat jaded perspective. I think a similar critique is in order for your reader.

In any given month, a perfectly fertile couple only has about a 20% chance of conceiving a child if they are trying.

So, a fertile couple doing it the “old fashioned” way, has a roughly 80% fail rate. Suddenly, the 23% success rate of frozen eggs does not seem to shabby, no? In fact, the very study that Tsigdinos cited to support her argument reached a positive conclusion relative to the achieved probabilities. This is why fertility doctors do not take on patients until they have been trying for a year without success; prior to that point, the lack of conception may very well be just due to bad dice rolls.

Here is a PDF on Penn Fertility data on embryo transfers. Of note, they are talking about embryo transfers, which is after the first culling of eggs. They do not appear to post data on frozen eggs but do state the following:

Pregnancy using already retrieved, frozen donor eggs is an incredible step forward and is possible because of the dramatic improvement in egg freezing technology. Methods of rapid freezing called vitrification are now used effectively to freeze eggs. Several large studies have been conducted using frozen donor eggs and indicate that pregnancy rates are no different when fresh or frozen eggs are used.

Under normal circumstances during ovulation, a series of things has to go right in order for a child to arrive. Sex has to happen at the right time, egg and sperm need to meet – the right egg and sperm need to meet – implantation needs to occur, and then the body needs to get on board with the pregnancy. A lot can and does go wrong between a couple having sex and a baby being the result. In fact, one of the most frustrating parts of fertility treatment is the unknown. As of now, in the midst of infertility treatment, our infertility remains “unexplained”.

The problem here is that we are talking about eggs, and our perspective gets skewed when we pull them out of a woman’s body and get to actually trace the failure rates. IVF is instructive in thinking about this. The general rule is that 50% of the retrieved eggs will not fertilize and/or reach a point where transfer is a viable option. Of the resulting 3- and 5-day embryos, a further 50% will not result in a child. What does that mean? We are back in the same ballpark of 25% of retrieved eggs resulting in a child. This is indeed sobering when you break it down, particularly for older women with weaker egg reserves. If you pull less than 8 eggs, the probabilistic expectation is for a single child to result (if that). That, however, needs to be placed alongside the fact that a fertile couple trying for 8 months would be expected to produce <2 children.

With the advent of vitrification as a technique, I suspect we will see freezing become much more common in the years ahead. The practice my wife and I are going to has data that suggests frozen embryo transfers may result in a higher rate of pregnancies than fresh transfers. If true, the reason is most likely a byproduct of the hormonal treatments involved in stimulation and retrieval. An even greater advantage is that freezing effectively stops the clock on egg/embryo aging. So, if you freeze an egg/embryo at age 25, you can transfer it at age 37, and genetically it will be as if you conceived the child at 25 (this has significant benefit given the data we have on egg reserves for 35+ women).

None of this is to suggest that freezing eggs should suddenly become Plan A. There are very real and scary potential side effects of the stimulation and retrieval process, and I worry about the long-term impact on my wife’s health.

That being said, I think expanding coverage for this procedure should be applauded, since it creates an option for women. What the data pretty much universally suggest is that women are much better off making a decision about having a family prior to hitting age 35. After that, the statistics begin to drop rapidly. So if you are an early 30s woman who wishes to have a family but are not ready to do so for whatever reason, freezing and banking eggs is something well worth considering.

Again, yes, the vast majority of the collected eggs will fail to result in a pregnancy – but that’s life, just as is the case in the wild.

Update from a reader:

Your reader is pretty much on the money. I went through two IVFs and have friends who did live and frozen transfers. Those are the stats.

The only kibble I have is about egg freezing versus embryo. Embies do well through the freezing process and the thawing. Eggs? Not so much. They are not like sperm, which also freezes and thaws fine. Eggs are much more fragile.

If companies were offering to help women harvest and fertilize eggs to create embryos for future use, THAT would be truly useful. But they aren’t. It feels more like a con.

That said, why has no one broached the subject of young men storing away their young healthy sperm for future use? The research on older fathers gets grimmer as time goes on, with a laundry lists of mental health, learning disorders and autism now being linked to “old” sperm.

A woman is born with all the eggs she will ever have. They age with her, but they were generated when she was so unlike males whose sperm quality gets spottier all the time because of the DNA damage we all pick up as we age, a woman’s eggs don’t have that particular downside to worry about. Which is why it would be great if they froze well – but they don’t.