Today, Explained - The failed promise of egg freezing

Episode Date: April 29, 2024

Egg freezing was once hailed as a reproductive game changer, but as Vox's Anna North reports, it might not live up to the hype. This episode was produced by Victoria Chamberlin, edited by Amina Al-Sadi, fact-checked by Laura Bullard, engineered by Patrick Boyd, and hosted by Noel King. Transcript at vox.com/todayexplained Support Today, Explained by making a financial contribution to Vox! vox.com/givepodcasts Learn more about your ad choices. Visit podcastchoices.com/adchoices

Have you ever wanted to freeze time to preserve life? For the past 12 or so years, the option of freezing eggs has been popular for women who may want kids but don't want them right now. If the perennial question is, can women have it all, could the answer be egg freezing? Some companies even started to offer to pay for the procedure, on average about $11,000 per cycle, as a perk of employment. With the great resignation in full swing, it's become hard for companies to hang on to their people. And so now we're seeing egg freezing, IVF, and others emerging as a whole new category of benefits up for grabs. And now, a dozen years on, we're getting the data on how well this process has been working for women and for families. And those outcomes are coming up on Today Explained.

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please contact Connex Ontario at 1-866-531-2600 to speak to an advisor free of charge. BetMGM operates pursuant to an operating agreement with iGaming Ontario. Call your cable provider and kindly demand that Today Explained is added to your lineup. Call and subscribe today. My name is Anna North. I'm a senior correspondent for Vox.com, where I cover American family life, child care, education, and a whole lot of other things. You recently wrote a piece for Vox about women freezing their eggs. And you noted in this piece that women sometimes talk about freezing their eggs as kind of an insurance policy against time.

You know, I freeze now and then I fertilize when it's convenient. Is it working the way we seem to think it is working? We now have more data than ever about the effectiveness of egg freezing. And while it is working for some people, and some people go and have a great experience, it has failed to live up to some of its early hype. I think at the beginning, it was thought this is going to usher in this new era of gender equality. Tech giants Facebook and Apple confirming they will pay for female employees to freeze their eggs. Telling ABC News, we want to empower women at Apple to do the best work of their lives. It seemed sort of careless of me not to take advantage of the fact that

I can't stop myself from aging. I can't fall in love overnight, but I am able to stop the aging of my eggs. It's going to free people to pursue careers in a really different way. But now there are a lot of concerns with some experts saying this procedure really just serves as another way for companies to make money from stoking women's anxieties. What was the promise? Like, if you could boil it down to a few words, when women were sold on freezing their eggs, what were they told? Around 2014, when this procedure was really becoming more mainstream, there was a thought that it would be as big as the birth control pill

in terms of how much it would change people's lives. And then there's this really famous 2014 Bloomberg Businessweek cover story that used the phrase, freeze your eggs, free your career. Imagine a world in which life isn't dictated by a biological clock. If a 25-year-old banks her eggs and 35 is up for a huge promotion, she can go for it wholeheartedly without worrying about missing out on having a baby. So there was this idea it's going to upend gender roles, it's going to upend the way that women might be discriminated against in the workplace. Indeed, if you look at the dominant marriage strategy in 1980, it was for men to delay their parenthood

and then marry and impregnate younger women. Now, in the 2010s, we actually have a more gender-equitable strategy where both partners can invest in themselves and delay. It's going to change everything almost the way that birth control changed everything in the 1940s. The first successful births from frozen eggs were actually all the way back in 1986, a pair of twins born in Australia. That turned out to be kind of difficult to replicate for a long time.

So egg freezing doesn't really take off until the 1990s, starting at a clinic in Italy. So the Italian government was about to pass a law restricting the use of frozen embryos. So that's when the egg is fertilized with sperm and starts to grow. Restricting the use of frozen embryos on the grounds that they constituted human life. And so freezing the eggs instead became a way to get around this law and still treat patients with infertility. Then we fast forward a little bit in the early 2000s. The procedure starts to spread more to the United States, around the world. Probably when this comes into its own, it will be more liberating to women than the

oral contraceptives were back in the 1960s. A lot of people who were freezing their eggs had a medical condition that really made it necessary in some ways to preserve fertility. So, for example, people who were about to undergo chemotherapy for cancer, which might impact their fertility, starts to really get a lot of mainstream interest in 2012 when the American Society for Reproductive Medicine announced it should no longer be considered experimental. It said babies born from frozen eggs are as healthy as those from fresh eggs. But the committee said the procedure should be limited in its use. In 2012, what really changed is people starting to freeze their eggs

more because they weren't in a position to have children right then. They didn't necessarily have a medical condition, but they hadn't met the right partner. There were career concerns. I thought it would be really nice if I could make it so that I had a baby when my life was ready instead of just because my body is ready. So there was this big change in the way that egg freezing was used. How does this process actually work?

The procedure starts with 10 to 14 days of hormone injections, often two or three per day, to kind of stimulate the ovaries to produce more eggs than normal. Typically in a cycle, the body is producing like one, maybe two eggs. But in order to harvest eggs for egg freezing, you want the ovaries to make a bunch more. So you're taking these medications. You're either injecting them yourself. If you have a partner, you can get the partner to do it. You can get a friend to do it, but it's needles, right? And then you're typically going to a clinic two to three times a week for ultrasounds, blood work. You're monitoring the whole process. Finally, when the eggs are the right size, the doctor says you're ready. You take another injection, a trigger shot

that's designed to kind of complete that maturation process. About 36 hours after that trigger shot, and this has to be timed really well, you'll go in. A doctor will extract the eggs using a needle that actually threads up through the vagina into the ovary. And it's not a super risky procedure, but there's a small risk. There can be complications. You can experience blood clots. You can have something called an ovarian torsion, which is as bad as it sounds. But if everything goes well, if you're under 38, you might get between 10 and 20 eggs. And then they put the eggs on liquid nitrogen.

They put them on ice. And you basically store them away until at some point maybe you want to use them. Okay, so you just walked us through what it's like to do that process one time. What would that one time cost? It's a lot of money, usually five figures. Wow. Between $10,000 and $15,000 a cycle. One patient I talked to, she froze her eggs in 2022, so pretty recently, cost her about $14,000. And that included some storage fees. Now, storage fees are going up. They can be about $800 a year or more. So you do that initial, you know, 10K-ish round, right? But you're still paying in the hundreds every year to keep those eggs and make sure they're safe for when you might want to use them.

One of the big promises, as you've laid out, is that freezing your eggs allows you time to do things at your own pace. Is that true? How long do a woman's eggs actually remain viable once they've been frozen? The freezing process has gotten better over time, but eggs contain a lot of water, so they're a little harder to freeze than some other tissues in the human body, including actually fertilized embryos. So there's going to be some potentially that are lost when you thaw them. It's not a perfect process. It's also the case that your own body, you can't necessarily support a pregnancy forever.

So at a certain point, if you're looking at after 45, things like this, it might be harder and harder to be forever. So, you know, at a certain point, if you're looking at after 45, things like this, it might be harder and harder to be pregnant. It's less about how long the eggs last once they're frozen and more about how old were you when you froze them and how good quality were they when they were frozen and how many were they. You know, if you only froze four, then you've got to hope that one of those fertilizes. It's just, it's a numbers game. Okay, so we have an expensive process and typically things like this do get cheaper over time.

They go from being like a super rare thing to more common. This has become a huge growth industry. Can you talk us through the process of it being very rare to it being highly available to anybody who has those five figures? So in 2012, after the American Society of Reproductive Medicine says this is no longer experimental, from there we kind of get this explosion in media coverage. And so now we're seeing egg freezing. A national medical group decided that freezing eggs is showing a lot of promise.

And then we're also seeing these new companies spring up specifically to offer and market egg freezing. KindBody is reinventing the women's health care experience for the modern woman. Extend Fertility, which was launched in 2016, offered Instagram influencers reduced rates in exchange for posting about egg freezing. There was a quote-unquote fertility studio called Trellis that opened in the Flatiron in Manhattan in 2018, called itself the Equinox of Egg Freezing. The startup KindBody, which was also launched in 2018, had parties with drinks and scented candles. The women invited to this party all have something in common. They're successful in their careers with no immediate plans to have children, but they know their eggs will never be as healthy

as they are now. It feels like there's a lot of pressure to find the right person and the clock is ticking and you don't want to be rushing that. A lot of these companies would have kind of a distinctly like millennial 2010s ethos and these taglines like plan your path or it's really about like empowerment and women's empowerment. And there was a girl boss vibe, I think, to this era. It's just about hanging out and realizing that you're not alone. There are a lot of women out there just like you. Who are you targeting specifically? Anyone with a question about whether egg freezing is for them. And we do get this real skyrocketing popularity.

So the figure that I've seen is about 2,500 people were freezing their eggs in 2012. And by 2020, that was 13,000. Vox's Anna North, she'll be back, along with writer Maymay Fox, who is among the thousands of women who were told that freezing eggs was a way to buy them more time. Maymay's going to tell us what happened to her? Support for Today Explained comes from Aura.

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And because she's a little bit older, it was just easier for us to source all the images together and have them uploaded to the frame itself. And because we're all connected over text message, it was just so easy to send a link to everybody. You can save on the perfect gift by visiting AuraFrames.com to get $35 off Aura's best-selling Carvermat frames with promo code EXPLAINED at checkout. That's A-U-R-A frames.com promo code EXPLAINED. This deal is exclusive to listeners and available just in time for the holidays. Terms and conditions do apply. Support for this show comes from the ACLU. The ACLU knows exactly what threats a second Donald Trump term presents.

And they are ready with a battle-tested playbook. The ACLU took legal action against the first Trump administration 434 times. And they will do it again to protect immigrants' rights, defend reproductive freedom, fight discrimination, and fight for all of our fundamental rights and freedoms. This Giving Tuesday, you can support the ACLU. With your help, they can stop the extreme Project 2025 agenda. Join the ACLU at aclu.org today. This is Today Explained. I've always wanted to have children my entire life, and I love being around kids. I desperately want to have my own, but I have

gone through a divorce when I was in my early 30s that left me single at this stage of my life. I was ghostwriting a book for Sarah Brokaw, and we went into the office of a fertility doctor, Dr. Jamie Griffo at NYU to interview him about fertility issues. And at this point, I'm 37 years old and I'm in excellent health. So I'm just thinking that I'm not going to have any trouble getting pregnant if and when I finally meet the love of my life. So we go into the office and he sits us down at a table and he shows us a chart.

This is a graph that illustrates the rate of infertility of women after the age of 35. And it isn't a gradual decline in fertility as I had imagined. It is an exponential curve. So with each passing month after the age of 35, your chances of conceiving a child are exponentially less. And I'm able to ask Dr. Griffo, what about me? I'm in perfect health. I do yoga. I eat well. I've never been a smoker. This isn't true for me, right? And he's just like, no,

that has nothing to do with it. These eggs have been in your body since you were born, and this is a degradation that happens to every woman as a result of age. I am shocked and devastated, and my eyes are wide, and then we're talking to him about what are your options? And one of the options at this time was still considered an experimental procedure, freezing your eggs. I wanted to have children with a partner, but I was single and I didn't have a partner. So I was like, gosh, I better freeze my eggs. There was starting to be a lot of chatter in the media. And there were women throwing egg freezing parties. And it was very much seen as your insurance policy.

Why wouldn't you do this? Why wouldn't you go get insurance if you have a choice? If medically you're able to do it if medically you're able to do it and financially you're able to do it, why wouldn't you? So I scrounged up $10,000, which is a lot of money for me at the time, and I went through the process of freezing my eggs. And it was very successful, I was told. I had 18 frozen eggs. It was a terrific number for my age. They all looked healthy. I had really great hormone numbers and everything looked strong. So I had my insurance policy. That piece of it was really important to me that psychologically at that point, I relaxed a little bit about the

ticking clock and I was able to go back to dating with more confidence and more calm and more presence to just like, let's enjoy this process instead of being in a blind panic about, oh my God, I have to meet a guy so I can get married and have kids. Shortly thereafter, I went to Costa Rica to learn to surf and to write, and I met the love of my life, my husband, Kiran Ramchandran. And it still took us a few years to get together. We were both involved in sort of on-again, off-again relationships. And eventually, three years later, I moved down to LA and we decided to get married and immediately start trying to have kids because I was rapidly approaching my 40th birthday and he was a

little bit older at 42. We got pregnant. We were thrilled over the moon. And then I miscarried, which was devastating. And at that point, we went in to see the fertility doctor in LA. And he said, look, why don't you use those frozen eggs? This is the perfect opportunity. And I thought, that's a great idea. Let's do it. So we arranged for them to be shipped from Stanford facility in San Francisco down to LA. And the morning that my eggs arrived in Los Angeles was the worst day of my life. I get a call from the fertility doctor And he says, I have bad news. Are you sitting down? All your eggs were destroyed in shipping. And as you might imagine, my first reaction was just

confusion. I asked a million questions. Why? What happened? He said, well, it looks like they were mispacked it was like what what are you talking about he said do you want to come in and see and I said absolutely so Kiran and I drove to the doctor's office in LA and he showed us these vials where the tops had not been appropriately sealed it had not been packaged so if you can imagine taking eggs that you buy from the store and instead of them being carefully packaged in cartons that protect them during shipping, they're just kind of all tossed into one bin together. I was so heartbroken. I mean, and felt angry at the universe and had to do a lot of work to get past it. One of my decisions actually was to file a lawsuit against Stanford for medical negligence.

And we actually did file a lawsuit and it went to court and the judge threw it out because he said it was an experimental procedure. No one told me there was any risk involved in shipping and that would have been so easily solved. I mean, I was in LA and I could have easily flown up to San Francisco and had the procedure done entirely there if I had been told that there was a risk in shipping, which I was not. That was Maymay Fox. She's a New York Times bestselling author and editor and a contributor to Forbes. All right. Vox's Anna North is back with us now. So Anna, Maymay was a source in your Vox story about egg freezing. That's how

we met her. Can you tell us how common stories like hers really are? She's not the only person to have encountered problems with egg transportation or egg storage. There was a 2022 study that found at least nine storage tank failures over 15 years, affecting 1,800 patients. And then, you know, those are sort of the technological problems. These are accidents, maybe things that wouldn't be expected. But egg freezing patients also kind of have to contend with the fact that the human body itself is unpredictable, even with this new technology. So there's just really a lot of points at which egg freezing can fail. And a doctor who studies this really walked me through it.

First of all, the ovaries might not produce enough eggs, even with the medications that are supposed to make them do that. The eggs might not survive the freezing process. When they're thawed, they might not fertilize properly. And then if they're fertilized, those embryos might not implant properly in the uterus. So, you know, just like with anything around pregnancy and fertility, there's a lot of uncertainties really baked into the process. Are any of these companies able to tell you, or is any of the data able to tell you, like, how frequently this happens? So is it possible to say if you freeze your eggs about half the time, it's not going to result in a viable pregnancy? Do we have numbers like that? Increasingly, we have data. There's a 2022 study out of NYU that got a lot of attention. They found that the chance of a live birth from frozen eggs overall was about 39%.

Now, that chance goes up if the person is younger when they freeze eggs, and it also goes up the more eggs you freeze. So if you freeze a lot, you have a better chance of some of them fertilizing and becoming viable. But what the study author Sarah Cascante told me is there isn't a guarantee of having a baby from egg freezing. Would you characterize it as a necessary thing to do? Or who would it be necessary for?

I think it's so complicated. When I talked to doctors, there sort of was a sweet spot of like a person that they might counsel to consider egg freezing. But, you know, that person is not 22, right? Because someone who's quite young, they have a lot of time to build their life in different ways. They have a lot of time to conceive without assistance. There's not really a need, even though there are some companies that have marketed to very young people about this, there's not really a need, a lot of experts told me, for someone who's quite young to go through this whole process that costs thousands of dollars, that involves giving yourself shots,

that involves some risk of getting sick, you know, for something that they're probably not going to use. Even for people who freeze their eggs, they're not typically going back and using them. Only about 12% of patients worldwide actually go back to use those frozen eggs. So a lot of times they're conceiving without assistance or they're deciding not to become parents or maybe they're becoming parents through adoption or they're becoming parents through partnering with someone who has children of their own. You know, it's something that I do think a lot of people like to have. And people who freeze their eggs typically report kind of a feeling of empowerment and a feeling like their stress levels went down, they did something for themselves.

But it's actually not something that people are using biologically for the most part to build their families. All of that was really a dark, dark period in my life. I will say that the good news is we went on to do several rounds of IVF and on the third round, we were successful. And not only that, but we tried for twins and we succeeded. And I now have beautiful, healthy twin boys. So the story has a happy ending, but it was definitely not what I expected.

That was Maymay Fox. We're all very happy for her. And you also heard from Vox senior correspondent Anna North. Victoria Chamberlain produced today's show and Amina El-Sadi edited. Patrick Boyd engineered. Facts by Laura Bullard. I'm Noelle King. It's Today Explained.