Elective Egg Freezing as a Poor Solution

Creating Professional and Social Expectations on Women? 

Elective Egg Freezing is unlike medically necessary healthcare or cosmetic surgery which is generally understood as a luxury. EEF is instead offered as a choice at the nexus of a woman’s career and her desire to have children. The introduction of choice at this intersection creates expectations that women should now do both since they can to be maximally successful in both arenas.

Could the availing of this choice, ironically be counterproductive to the objective of liberating women from restrictions and pressures by subjecting them to new pressures to excel at both now that they can legally do so?

Will we see shifts in expectations from society, or within oneself, in relation to reproductive attitudes where women may face direct or indirect pressures to prioritise their careers over childbearing?

Could a dark side of corporate sponsorship of egg freezing come with the unspoken expectation that higher-level female employees should prioritise career and delay childbearing in order to stay on track for promotions and bonuses?

At the level of social expectations, what we do know is that a 2013 study of 129 women who chose to freeze their eggs, found that they were primarily motivated by a desire to avoid future self-blame. The vast majority of respondents chose the option in the survey: “I want to know I did everything I could, I don’t want to blame myself later”.

Fear is a business opportunity. Could we see EEF marketed by Femtech as an insurance policy hedging against fears of being left on the shelf? Worse still, are we accidentally creating an expectation that women should use the option while young because it is seen to be the “responsible” choice?

More akin to Gambling than Insurance

In this light, some may see the choice to pursue EEF as an insurance policy to hedge against future uncertainty. Yet, fairly poor odds that EEF will help older women bear children make it more akin to an expensive gamble than it has with the certainty of insurance.

It’s no secret that the buy-in for a seat at the table is financial and physiological. Financially, the estimated cost of one cycle of egg freezing is $10,000. This is a numbers game. Doctors recommend that each woman goes through one to three cycles of egg freezing in order to retrieve as many eggs as they can to maximise the chances of live birth. More eggs, more chance. But also, more money – a lot more. On top of this, there are the costs of storage and travel which will likely bring the costs into the tens of thousands.

Actress Ase Wang, 40, who comes from the family which owns Phoon Huat, paid $45,000 for three cycles of egg freezing and had mood swings from the daily hormonal injections. Ase managed to freeze 17 eggs in all, but to have better odds, some doctors recommend freezing at least 20 eggs which usually involves multiple rounds of the invasive procedure.

There’s the cost.

Here are the odds.

While reproductive technologies give an illusion that we can bear children whenever we want, a look at the data shows that these technologies only marginally improve the ability to conceive.

Studies have found that a very small proportion of women – fewer than 10% – use their frozen eggs in the end. That’s a lot of women who bore the cost but never returned to use their frozen eggs. One wonders if this could have been avoided if only ARTs were marketed more responsibly.

After harvesting, eggs are frozen for storage and then thawed when a woman wants to use them. “Not all eggs survive the process of being frozen, and not all that are frozen will survive the thawing,” says Dr Pamela Tan of TLC Gynaecology Practice at Thompson Medical Centre.

But a successful thaw without damage does not mean a baby will ultimately be born. An egg must then be fertilised with sperm in the lab using a process called ‘intracytoplasmic sperm injection or ICSI, but not all remaining eggs will be fertilised by the sperm.

If the fertilisation is successful, the fertilised egg must grow into an embryo for about five days, screened for genetic abnormalities. Depending on a woman’s age and quality of oocytes, one’s embryos may or may not be of good quality. As such, not all embryos will be implanted into the womb. And beyond that, not all embryos that are implanted will be normal, carried to term and result in a live birth.

“The odds of success at each step are far below 100%” according to Drs Randi Goldman and Janis Fox, clinical instructors of reproductive endocrinology and infertility at Harvard and Brigham and Women’s Hospital.

Dismal Statistics for EEF across several analytical models.

Several studies have been undertaken to look at success rates from EEF across different variables. The results of each study vary by the motivation of the research body and the variables studied.

According to the American Society of Reproductive Medicine, the chance of a frozen egg leading to a baby being born is about 2% to 12%.

In Dr Goldman and Dr Fox’s model (2017), a 36-year-old woman who freezes 10 eggs is predicted to have a 60 per cent chance of at least one live birth based on 520 IVF cycles in healthy women.

Whereas a 2016 study by researchers in Spain, which involved 137 women whose frozen eggs were thawed, was less optimistic, predicting that women 36 and older who freeze ten eggs have a 29.7 per cent chance of giving birth.

In 2018, femtech provider Extend Fertility synthesised both datasets to produce the following table (in link).

For between $30,000-$50,000 for older women, those are raw odds. Fortunately, Singapore’s proposed age cap is 35 years – a wise policy decision to protect women from desperate gambles in different desperate times.

Between the hope proffered by success stories, inflated promises from Femtech Marketing and a low success rates, women are indeed caught in difficult straits. And at the end of the day, Femtech makes bank. 

Do the costs and success rates warrant attempting to take this gamble, or are there other paradigmatic options that women should pursue instead of Social Egg Freezing? We believe so. For those who have the option to, the best course of action is to have children as young as they can and not put off childbearing. There is natural beauty in young families which grow older together.