A few summers ago I was sitting in my parents’ garden in Massachusetts with a couple of their friends, successful Americans working in science and technology and accustomed to dishing out their opinions with zest and data-driven backing. One such opinion — offered with startling intensity — was that I ought to waste no time in freezing my eggs.
Indeed, that I ought to have done it years ago; at 35, I was already over the hill, egg-quality wise. Their daughter, they said, had already frozen hers — aged 25, when the eggs are in prime health. In the UK, there is a 10-year storage limit on egg-freezing, which is why women here rarely consider it in their 20s; most aren’t ready to give up the ghost of finding a partner and conceiving naturally in their 30s. The US has no such limit.
The advice from my parents’ friends came at a time when I’d already considered egg-freezing or “oocyte cryopreservation”, in industry jargon. By the time 35 loomed, the message had reached me loud and clear that my fertility was about to hit a perilous cliff-edge. Should I act? I was just on the way out of a long-term relationship, was hungry for fun and freedom, and having children then held no appeal. I wasn’t sure I’d ever want kids. The only thing I knew for sure was that I didn’t want to think about it. After a brief bit of research, which showed that less than 1% of frozen eggs end up becoming babies, I put the whole thing aside as too remote for serious consideration.
Now, in 2020, egg-freezing merits fresh thought. The pandemic has exacted revenge on those who planned to wait and see what unfolded. The clock has stopped — all the hurly burly of social life has been suspended — but bodies are still ageing. This has put particular pressure on single women in their late 30s, for whom in a stroke all possibilities of conception seemed to evaporate when in-person dating became lethally risky and fertility clinics had to be closed.
Clinics were able to apply to reopen in May, and I know a number of women who — feeling the dread and panic of a socially, professionally and quite possibly romantically aborted year or even two — are considering either egg-freezing or going ahead with sperm donor insemination. The option to “wait and see” has lost its air of promise.For those who don’t want to take the plunge of a pregnancy yet, the temptation to pay through the nose to freeze eggs — £8,000 per cycle, with three cycles recommended — is strong as the world becomes more uncertain.
In the past few years, the procedure has been glamorised by celebrities including Rita Ora and Sofía Vergara. American companies from Uber to Unilever now offer egg-freezing benefits to female staff. So far, so empowering. But despite the hype, egg-freezing remains a marginal practice in the UK. According to the fertility regulator, in 2017 there were just 1,463 egg freezing cycles (compared to 70,000 IVF treatment cycles) — up from 816 in 2014. Between 2010 and 2017, only 700 babies were born through frozen eggs in the UK — compared to 732,000 total live births per year. The number of “thaw cycles” of patients’ own eggs, rather than donor eggs, was only 178 in 2016. So this is still very far from being a mainstream salve for women unsure about the future, though that does appear to be changing.
For the many women who feel time is running out — fertility campaigns since the 1980s have ensured awareness of a number of cliff-edges, from 30 to 35 and now 37 and 40 — egg-freezing has been presented as a way to defer the plunge-taking (or not) that biology eventually demands of us, whether we have a partner and a good job or not. It therefore provides intense psychological relief, like any insurance policy. Marcia Inhorn, a sociologist of assisted reproduction at Yale, and the author of a large-scale study on the reasons American women freeze their eggs, told me: “The overwhelming majority of women who did freeze their eggs, and got a decent response, felt relief — they felt they could take the pressure of time off. People used ‘peace of mind’, the ‘pressure’s off a bit’. A lot of it was put into psychological terms.”
Mental relief is clearly a payoff for those who choose to undergo the expensive, invasive ordeal of egg-freezing cycles. But most women still want to wait for a partner before defrosting and if no such person materialises, they leave the eggs untouched. Or they find partners and get pregnant naturally. But for those who do want to use their eggs, only 19% of IVF treatments using those eggs result in live births (according to 2017 figures), compared to 30% when donor eggs are used, though most women don’t envision using donor eggs to get pregnant. If egg-freezing is an insurance policy, it’s not good value: the chance it will pay out is small.
And the costs are staggering. Women have to pay for egg-collection and freezing (£3,350 per cycle), medication (£500-£1500), egg-storage cost (£125-£300 per year), thaw cycle and embryo transfer (£2,500). The procedure, which involves women making repeated trips for scans to the clinic, injecting themselves with hormones and then undergoing egg retrieval under general anaesthetic, can be gruelling. Some women are going public with regrets, particularly over the high costs and eventual abandonment of the eggs. Hannah Selinger, who froze her eggs in the US aged 34, wrote a piece in Glamour headlined: “I spent $17k freezing my eggs and regret every penny”.
Beyond the nitty gritty of cost and outcomes, the egg-freezing phenomenon houses an unpleasant paradox: when women actually want to freeze their eggs, and do so, those eggs are far less worth freezing. Women over 35 who freeze their eggs have a considerably lower chance of being able to make viable embryos out of them than younger women. Over 37, the quality and viability plummets further. And yet 38 is the most common year for women to freeze their eggs — this is when women really want it, can afford it, and are ready. Yet it is also the moment the benefits of doing so shrink. At the best age for freezing viable eggs, under 30, few women want to even think about it. And why should they? Infertility is a future and uncertain problem. Still, they are told that this attitude may mean hell to pay later — even though there’s only a 30% chance that IVF cycles using eggs frozen at peak fertility will lead to pregnancy.
But the most insidious aspect of it all, perhaps, is that while egg-freezing promises empowerment to women, it also adds queasily to the pressure. Zeynep Gurtin, a sociologist of reproductive technologies at UCL, told me that “reproductive anxiety”, an idea she has developed with her colleague Charlotte Faircloth, is an increasingly pronounced part of women’s lives, with the onus on women to constantly engage in “responsible decision-making” to manage their fertility. “If you fail it’s your fault, you didn’t go to enough experts”; spend enough money, take enough steps.
Of course, women have long been hounded about the passage of time and the dangers of a laggardly approach to their fertility. A 1973 advert for Ivy Gibson, a London matchmaker, asked women: “Are you under 30? Are the years ticking off, NEVER to come back?!” In 1982, the New England Journal of Medicine reported that between the ages of 31 and 35 women stood a 40% chance of being infertile. It went from there.
As Susan Faludi wrote in her 1991 classic Backlash: The Undeclared War Against Women: “Like the children’s game of Chinese whispers, as the 40 per cent figure got passed along it kept getting larger. A self-help book was soon reporting that women in their thirties actually faced a ‘shocking 68 per cent’ chance of infertility — and promptly faulted the feminists, who had failed to advise women on the biological drawbacks which went with a successful career”.
The timescales have since lengthened — the fearful numbers are now 35 and 37 — and, thanks to the evolution of a more progressive gender politics, feminine milestones have diversified and the overtly anti-feminist agenda in terrorising women about fertility has been softened.
Still, the driving pressure remains. Egg-freezing may help free some women from the old harness of time. But it has also helped tighten the screw, at eye-watering cost, and with a low chance of ultimate success.