The current state of fertility preservation

Posted on April 25, 2018

Cryopreservation in human reproduction has been around since the 1950s when the first reports of pregnancies from frozen sperm were published. It took another 30 years before embryo cryopreservation became possible and though the first frozen egg baby was born in 1986, it took 11 more years to get just 8 more live births.

The introduction of the freezing technique known as ‘vitrification’ in the early part of the 2000s made egg freezing much more efficient. As a result, we are now experiencing an explosion in elective egg freezing treatment cycles. The number of cycles of egg freezing in the USA can be gleaned from yearly CDC data and best estimates are that the number has grown from a few hundred in 2005 to as many as 7000 in 2017. Many think this number will continue to grow. Most of that growth is located in large cities like New York, Houston, Chicago, San Francisco and Los Angeles, but other large metro areas, like Atlanta, are seeing growth in egg freezing cycles too.

The technology itself is driving some of the increase in fertility preservation but more and more women report that they are making the choice to freeze their eggs because they just haven’t found ‘Mr. Right’ quite yet. Some freeze because of education or career, but contrary to popular belief, the decision to freeze seems to be related to the fact that modern men are in no rush to get married and start families and women unfortunately don’t have eggs with unlimited shelf-lives.

For women who choose to freeze, there are few things to consider before choosing an IVF center to have to the process done. Vitrification is a user-dependent freezing technique, meaning that the person who performs the freeze will influence how well the eggs will work when they are warmed up. Centers with long experience and designated ‘vitrifiers’ on staff tend to have better results. There is VERY little data on outcomes, one of the fair criticisms that the American Society of Reproductive Medicine has for clinics that routinely offer the procedure, but a good guess as to how well eggs can perform from freezing can be inferred by checking a clinic’s ‘frozen donor egg’ pregnancy rate. This number shows how well a clinic handles frozen eggs and is a good measure of how well the clinic freezes them in the first place.

Patients should also consider how many kids they hope to have and plan for egg freezing accordingly. A 38 year-old who only wants one baby may not need more than one retrieval to get enough eggs for just one; and she may not need eggs in reserve at all, while a 34 year old who wants three or four kids may need to go through several egg collections. The chance of pregnancy is mostly related to a woman’s age, where a single embryo from a 30 year-old has about a 50% chance of making a baby but an equally good looking embryo from a 40 year old woman only has about a 15% chance of working.

Cost is also a concern. Most clinics charge between 6,000 and 8,000 for each egg collection and the cost of the drug from a discount pharmacy for the stimulation can run as much as 7000 in some patients. At RBA/Prelude, we have negotiated a substantial discount on medications for fertility preservation and can guarantee that a patient in our Prelude Pathway for fertility preservation will spend no more than 11,500 including medication while most will spend less than 10,000 in total.

Lastly, patients should also consider the limits of the technology before deciding to proceed. It is not possible to guarantee live births from any fertility technology and despite our success with vitrification, some patient’s eggs won’t provide them with the family they hoped for. The biggest limit on the technology is human reproduction itself. Nature never intended for us to live this long or delay childbearing at all. As a result, this is the first generation of human beings to experience the consequences of not using eggs while they are still ‘good’. The technology has the ability to preserve the fertility of our youth, but only if we choose to store our eggs (and sperm) when we need them the least, when they are still ‘good’ and plentiful and we are perfectly fertile.

The good news for women is that they have the ability to act to achieve the family they want without committing to a relationship until both are ready and until both want children. Similarly, egg freezing gives women the ability to be single mothers by choice when they feel emotionally and financially ready to do so.

Daniel Shapiro, MD