The Decibel - A reality check on the fertility promises of egg-freezing

Episode Date: August 17, 2023

Elective egg freezing is on the rise in Canada. Fertility clinics pitch it as a kind of insurance policy: put your eggs in the bank now, and you can come back for them later, when you’re ready to have a baby. But the procedure is invasive, expensive, and doesn’t guarantee a successful pregnancy later on.Alison Motluk, freelance journalist and writer of the newsletter, Hey Reprotech, is on the show to talk about what’s really involved in egg freezing. Read more about why she’s sounding a note of caution around the procedure here.Questions? Comments? Ideas? Email us at [e-mail]

We agreed to get married as soon as you won your first case. Meanwhile, 10 years later, my niece, the daughter of my sister, is getting married. My biological clock is ticking like this, and the way this case is going, I ain't never getting married. When Marissa Tomei gave that speech to Joe Pesci in the 1992 film My Cousin Vinny, the option to freeze your eggs without a medical need was still 20 years away. Since then, rates of elective egg freezing have been on the rise, and we've seen a new industry crop up to address people's fears of running out of time to get pregnant. Fertility clinics are now advertising the procedure to people in their 20s and 30s.

Some even offer a group discount if you bring your friends. It's pitched as a kind of insurance policy, but results aren't guaranteed. Alison Motluck is a freelance journalist covering assisted reproduction, and she writes a newsletter called Hey ReproTech. She's on the show to tell us what's actually involved in egg freezing and what we can learn from its growing popularity. I'm Cheryl Sutherland, and this is The Decibel from The Globe and Mail. Alison, thanks so much for being here today. Thank you for having me. So you've been writing about assisted reproduction for more than 15 years, and I just want to know, how did the interview and I was going to write a story about it. I don't want you to

publish this because women are going to be knocking down my door trying to get this. But it stuck with me like, oh, he knows this is going to be a really big deal. And he was right. Yeah. How long has egg freezing been happening in Canada? Like when did it start? So egg freezing prior to 2012 did exist. It was a different process in the early 2000s. It wasn't very commonly done. It was a slow freeze process, but it started to pick up in North America, like 2010, 2012. In 2012, they actually lifted the experimental label in the US that gave it a huge push. That was around that time that we were moving from the slow freeze to the vitrification. The vitrification was already available, but it wasn't available everywhere. But vitrification meant that eggs were more likely

to survive. And that did change the picture. It made it much more appealing to everyone, the people offering it and the people buying it. When we say slow freeze versus vitrification, like what changed there? Like what were the differences there that made it actually more available to more people that wanted to have children? I think the key difference, it was like a technical difference, but the key difference was that when they were frozen slowly, ice crystals formed in the egg and damaged the egg. I think in the thawing, it just didn't work. And then when they could do this flash freeze, for whatever reason, it did not result in damaging the egg. The egg was much more difficult than an embryo to freeze.

So there are medical reasons for egg freezing, right? So for example, a person about to go through chemotherapy, you know, they might be advised to freeze their eggs to preserve them for the future. But, you know, for the topic of the show, I really want to focus specifically on elective egg freezing. How much has that industry grown in Canada in the last decade? I mean, I can't put a number on it, but it went from nothing to something that people talk about all the time. Every young woman at least knows what it is, and some of them are considering doing it. Top level here.

What is happening in this process? How are the eggs frozen? So in a nutshell, what happens is you take some drugs to stimulate egg production. So you produce extra eggs. You go into a clinic and they are taken out of your body and they are frozen until you're ready to use them. And then you have to go back if you want to use them. And who is performing these procedures and where? So the procedures are performed by doctors in fertility clinics that do all kinds of other things. I guess there are now some freestanding clinics that do specialize in egg freezing, but they're done by doctors. And then the freezing would be done by like an embryologist, I presume. And then they're stored. Okay. I mean, when it comes to these kind of things,

there's a cost involved, right? So can we talk about the cost associated with this elective egg freezing? The drugs cost, I don't know, I'm going to ballpark it around $5,000 or $6,000. And then I, it does vary, but let's just say the procedure could cost $8,000 or $10,000, the freezing. So we're looking at a total of around? Let's say $12,000. Let's just say $12,000 to get those eggs into store, like into the tank, just into the tank. Right, okay.

Yeah. And then after that, I mean, there's other costs involved. We don't have to get through the steps, but then like in total, how much can it cost up to? Like, is there a price tag or are we looking at 12? Is there more than that? Well, yeah, I think that's the part that I wish people thought about more. So I think the key thing to remember is once you extract these eggs and freeze them, you can't use them without medical help. So if you want to use those eggs, you are committing yourself to a medical procedure. You're committing yourself to a doctor

thawing and then a professional fertilizing them. So whoever your partner is, or if you're using a sperm donor, it's going to go through the clinic. It's not going to be sex. You're not going to produce a baby with these eggs in the usual way. And then you're going to require a lab to allow that embryo to grow. And then a doctor is going to have to take that embryo and place it in your body. And you're going to have to take more drugs to make your body believe you're pregnant. So all of that has to happen before you could have a baby using those eggs. So all of those things cost money. And, you know, it's about the same as IVF plus storage. So storage is like a three to $500 a year, plus the whole cost of IVF, like all together, one round with storage could cost you, you know, $25,000, I guess, and 40% chance of success, like not 100%.

That's, yeah, that's a lot of money for not a big odd there. So that's quite a, you know, something that people are really putting their hopes into. This is a medical procedure, but an elective medical procedure. So does the government cover any of these costs? Yeah, I mean, as far as I know, there's no significant kick in from any provincial government. And what about employer insurance programs? Because I'm reading now that there are employers that are providing this as an option to their employees. There are, and I find that fascinating. So on the one hand, it looks like the greatest thing, you know, like, oh, your employer's being so supportive, they're going

to help you freeze your eggs, you know, or at least part of the cost, you know, and isn't that wonderful? But let's just think about it for just one second. Like, what does that really mean? I think what it really means is your employer is saying, do not have children now. Put that off. Work for us. Put that off. Don't ask us to let you go on mat leave. Don't ask us to let you work ordinary hours. So put your eggs to the side, put your relationships to the side and think about that later. I think you should at least consider that that's what that means. Like it's, you know, maybe that's a great option for you, but or maybe that is your employer telling you they'd rather you were just like 100% employee and 0% like person. Yeah. I want to talk about social media part of this, because one of our producers mentioned that she's being served a number of egg freezing ads through her social media. And I just as a journalist who covers reproduction, what have you been hearing about about this type of marketing? I think it's really widespread. I mean, I don't get them,

of course, because they know I'm too old. But I'm certainly people have sent me a lot of these ads. I mean, egg freezing is one egg donation, surrogacy. They're all very, very skillful advertising campaigns. And I think that a lot of them are sort of fear based. I think that a lot of them are introducing the idea that, wow, you might really regret it if you don't do that. I mean, maybe you think you won't have trouble, but wow, will you ever regret it? So I think that this constant bombardment about egg freezing is a really, really well conducted campaign to get women to worry about their fertility rather than think about it sort of more rationally and understand that, you know, they are reproductive beings. If they want to have children, they probably can. But the campaign is trying to make them feel really two things, actually. Nervous, but also hopeful. Like, hey, you don't have to worry about this now. You know, just put them in the freezer and you'll be fine to use them later. I think that's a little bit of a false promise.

They're selling kind of a hope then. A hope for the future. Yes. And also the hope that whenever it is you decide to use them, it'll be easier for you than if you decided to have a child right now. And I think that hope has to be examined as well. Like, is it really easier to have a baby when you're 45 or 48? Will your life really be that much easier? Will your workplace be more supportive? Are you more likely to have a partner then? All of those things I think are not certain. And in fact, it might be harder

for you. Your own parents might be older and unable to help you or they may need help themselves. Like a lot can change. And I think kicking the can down the road doesn't always solve the problem. And we mentioned briefly about how we're not being marketed to and that's fine. I'm in my late 30s, so I'm not the target. But of course, we know social media is very good at targeting their audience. Can we just talk about like who who is this being marketed to? I know that women in their late 20s and early 30s are the target are most likely to get these things. But young women are also now talking about it. And the reason I originally wrote my editorial was that I was in a seminar with some young women. They were either undergraduates, but they were young. They were in their early 20s. And that question came like, what do you think? And my fellow panelists said they thought egg freezing for this cohort, these young women, was a great idea. And I'm like, no, I don't agree with that. I don't think it's a great idea. So I think

all ages are targeted. I would think the younger ones are starting to be targeted more than they used to be. And in fact, I know in the US there was this thing like, one campaign was, you know, don't get a ring for your graduation, freeze your eggs, get your parents to buy you a round of egg freezing.

So we're talking young 20s. And I find that hard to take. We'll be right back. So we've laid out that egg freezing is becoming more mainstream and that certain demographics are getting ads asking them to freeze their eggs and maybe how convenient it might be for their lives. But this is a pretty involved process. And I'd really like to lay out just how involved it is so can you just walk me through the steps of how this would work for somebody so the things that would have to happen are you would have well you probably have to go through some baseline testing you would start injecting yourself with drugs and then you'd be going in for ultrasound scans as

well during that time to see how many follicles are developing, how many eggs are developing. And then you would take one final shot the 36 hours before the what they call the retrieval. And that would be if I recall, that's in your backside, I have not personally done this, then you would go into the clinic and have those eggs removed with that ultrasound guided needle that would go up through your vagina into your ovaries, into each follicle, sucking out the egg that would then be frozen by the lab. Of course, that's not the end of the process, right? First of all, if you don't get a lot of eggs, you might have to do that two or three times to have what they would think would be a good number to give you a good shot at a live birth later on. So you might have to go through that a couple of times. And then of course, you have to go through all of the process of thawing the egg, obtaining the sperm, having having it fertilized, having your body prepared for pregnancy, having that embryo placed into your body and then having a successful pregnancy and a live birth.

So it's sort of sold as you put it in the bank and you just take it out when you need it. And that's not really how it works. So essentially, you have to kind of finish this whole process with IVF, which is a whole process in itself. Yeah. And I mean, we know that fertility does decline as you get older. But I'm wondering, what do we know about the decline of an egg? You know, like maybe the goodness of an egg, as I'll call it. If you have eggs frozen from when you are 28, for example, is that better than someone 10 years older trying to get pregnant naturally? Like, is the 38 year old egg worse? Do we know anything about that? You know, I would love to see a study that really compared like if you took a 28 year old egg and you froze it versus a 38 year old egg, I would love to see those head

to head studies. I don't believe there are really, really good studies. I mean, what we do know is if you freeze it at 28, it's probably going to be better than if you freeze it at 38. But yeah, what we do know as well is that if you're 30 years old, if you don't have any like known infertility or known health issues, you have like a 90% chance of a natural conception. If you're 35, I think you still have like about a 75% chance. And so your odds are really quite good,

you know, as a woman trying to conceive in your early 30s. And even as you approach 40, I think it's still, you know, pushing 50%. And we all know women who in their, you know, late 30s, early 40s conceived without any trouble. The problem is we don't know which woman we are, right? I want to know also, like the people that do freeze their eggs, how many people actually go back for them? It's been very interesting to watch that. So right now, I think we know that about 10% of people are going back. So many, many people do not go back. We don't exactly know why. It could be that they were successful at having children. It could be that they wanted a partner. They never found a partner. So they never decided to go ahead and have children. It could be that they wanted a partner. They never found a

partner. So they never decided to go ahead and have children. And they've just changed their course of their life. Uh, we, or maybe they didn't have the money. We don't know. Um, I do expect that we're going to see more people coming back because I think that the people, you know, that we're measuring now were people freezing, you know, back when it wasn't a big thing. And now that people are planning it, like they're working it into their life, you know, their future life, that I think more people will go back. So you talked a little bit about this, but there is a lot of pressure on young people. You know, they're looking for job security in a time where the cost of living is soaring right now. It's more common to find a life partner or get married later in life.

And then on top of that, you might want to be thinking of having a family. So I don't know, does egg freezing, I guess, take some of that pressure off? I think it is sold as a way to take that pressure off. And I think in some cases, it will probably take the pressure off and result in a happy outcome. But I think in a lot of cases, I think maybe it will not result the way that

people had hoped. I think it's almost like a radical move right now for a woman to say, no, I'm not going to freeze my eggs. I'm actually going to have my family when I feel like having my family. And I want to have it when I'm young and my body's strong and my eggs are good. And, you know, my partner's sperm is good. And I'm just going to do that. You know, it feels almost radical to say that given that you have this out, this out of egg freezing. Like, again, I'm going to say when I was younger, there was no out. And so if I wanted to have a family, I had to just do it. And my employer wasn't happy either. Like, no, no employers are happy that their employees go off and give birth and are distracted for a little while with their young children. But that's just

part of life, right? We need to rethink how we do this. We need to make it easier for women in their 30s or late 20s who decide they're going to have their families, make it easier for them to do that. And, you know, childcare would be a great place to start. We brag about our maternity leave, but many, many people, I think more than half of women of childbearing age do not qualify for it. So if we actually had programs and ways of making it possible for women to have their children, families to have their children when they're able to, personally, I'd rather see that. I mean, this conversation has been focused on egg freezing, but I'm curious about, you know, this is 50% of the population. What about sperm here? Like, why aren't we talking about freezing sperm too? Yeah, it's so interesting. I mean, in general, sperm does not decline quite the same way that eggs do. But it does decline,

like it's, it's wrong to think that after age 40, there aren't implications, there are implications. But it is interesting that the industry, of course, has figured this out. There are now campaigns to get men to freeze their sperm, like, and it's the same kind of course, has figured this out. There are now campaigns to get men to freeze their sperm, like, and it's the same kind of principles, like, oh, don't, don't regret it. Anything could happen, you know, you should freeze some sperm while you have the chance. And so there are there are companies in the States where, you know, some of them would actually send you send you the kit, you can do it at home, or, or, of course, you're always able to go into a clinic. And it's much easier, though. It's much easier. It's much easier. But it's the same principle.

It's like, oh, you know, you might regret not doing this. And I find it fascinating. Just to end here, what would you say to someone who may have seen these ads and are considering getting their eggs frozen as a backup? What do you hope they would consider that might not be immediately obvious? I think that the thing I really want people to think about is egg freezing is a product. So it's a thing that someone is trying to sell to you. And they're trying to sell it to you as a way to give you more choice, right? It's like they're trying to sell you a thing that will make your life easier, give you so many more choices and options. But I think that

it's important to remember, it is a product being sold and marketed. I think that's the one thing that maybe in Canada, we're a little naive about because medicine is not normally sold to us. Like this is something that is being marketed to you in a clever, very specific way, trying to tell you that it will be easier for you if you put this off, give us this money and we will help you put it off. And I'm not convinced that it's easier to put it off. I don't think it's necessarily going to be easier for you when you are older and your parents are older and you're further along in your career. It's not necessarily going to be easier.

Alison, this has been a really interesting conversation. Thanks so much for being here today. Thank you. That's it for today. I'm Cheryl Sutherland. Michal Stein helped produce this episode. Nagin Nia is our summer producer. Our producers are Madeline White and Rachel Levy-McLaughlin. David Crosby edits the show. Adrian Chung is our senior producer. And Angela Pachenza is our executive editor.

Thanks for listening, and I'll talk to you tomorrow.