Thursday, November 20, 2014

To Freeze or Not to Freeze: Eggs and Fallen Dominoes


As you may have heard, Facebook and Apple announced last week that they are offering a new benefit for female employees: egg freezing. The benefit was met with a heated debate, as expected for any topic involving the female reproductive system. Though companies have now been blamed for forcing us to delay childbirth, egg freezing is a benefit, offered as a choice, and I personally support it.

Have you ever made a choice without realizing that a set of unseen domino pieces would fall, one after one, after your choice? I have, and I have felt like a total idiot wishing that someone would have explained that A leads to B and C and D. Egg freezing is one of those choices. We are misinformed about what "freezing our eggs" really means and my goal is to help us see some of the hidden domino pieces that fall after that decision. What is involved in freezing our eggs? What may be some good reasons to freeze our eggs? What are the trade-offs of the choice?

Let's talk egg freezing. Two short words for a rather long and invasive procedure in which a woman takes synthetic hormones that induce the production of not one egg, as generally occurs during the monthly cycle, but many, many eggs for the purpose of retrieval and freezing. I think it is important to understand the step-by-step here:

• Step 1: For one week prior to the scheduled retrieval, you will inject your own butt with FSH (follicle stimulation hormone), a synthetic hormone that will signal your ovaries to produce many eggs. FSH's common side effects are irritability and weight gain 
• Step 2: You will comply with ovarian monitoring, as in five to seven visits to a doctor's office for blood tests and ultrasound exams 
• Step 3: Once your doctor deems the eggs "ready," a late-night shot is necessary about 1.5 days before the retrieval
• Step 4: On the day of egg retrieval, you will receive mild sedation and anesthesia before the doctor retrieves your bounty of eggs
• Step 5: After the eggs are removed from the body, they are brought to the clinical laboratory where they are initially evaluated for health and then frozen
• Step 6: Over the week following the egg retrieval, you are to plan to recover from having your ovaries hyper-stimulated and you are to expect some additional abdominal bloating and discomfort.

So what may be some rational and good reasons to put yourself through this?
1.  You have not yet found a good sperm source. Some of us don't meet Mr. Right, or Mr. Half-Right, or Mr. Good-Enough-for-Now when our fertility is at our peak. Some of us don't meet that Miss Fine, who will want to build a family with the help of some sperm-bank acquired swimmers, until way after the ticking of our biological clocks begins to slow. And yet, we would like to preserve the chronological time of our eggs, so that when Mr. Right or Ms. Fine appears, we have an egg that is younger than we are. Being uncoupled is a good reason to freeze eggs.

2.  Your career is going really well, and you don't want a temporary interruption. Maybe you are at a growing company with stock options up the wazoo and this is your chance to build your and your future family's financial base; or maybe you are just this close to your next promotion. Now, note that children do not derail careers, and that the vast majority of women executives are married with children. But being pregnant and caring for an infant is a significant undertaking that automatically prioritizes itself, and thus you choose to attempt to find a better time when you can be more present so that the mere breathing of your baby in his or her crib can be the transcending experience nature intended.

3.  You don't feel ready to be a mother, or you don't know if you want to be one, but time is doing what it knows how to do. Then, find yourself. Challenge society's expectations of you. And if after all that you decide you would like to be a mother, then your frozen eggs give you the option to use the eggs of your younger, unfound, self.
Some women that freeze their eggs may think that they have just bought the ultimate insurance policy to birth a child whenever they decide. Dear, life doesn't work like that. Here are the dominoes that fall...

1.  When ready for pregnancy, you will need to use assisted reproduction technologyPractically speaking, the egg will be thawed and fertilized outside of your body with the sperm of your choice, then put back into your body. This is referred to as In Vitro Fertilization (IVF) and it is at least twice as expensive as freezing eggs. Romantically speaking, if you were clinging to that image of conceiving a child in passionate-hot-sweaty and/or tender-sweet-unifying lovemaking, then maybe you can begin to see the romance that practically seeps out of those stirrups at the doctor's office.

2.  Assisted reproduction technology success rates are lower than you may think. Each year the Center for Disease Control publishes the IVF success rates for the nation and by IVF clinic. The results for the 2012, which is the latest year analyzed, show that at a national level the percent of IVF cycles resulting in a live birth are not very high (read line "Percentage of cycles resulting in live births"): 31.3 percent for the younger set of women aged 35-37, 22.2 percent for women aged 38-40, 11.7 percent for women aged 41-42, 4.5 percent for women 43-44 and and as low as 1.8 percent for women older than 44 (full report available at CDC). Please take a moment to read these odds again.

3.  When ready for pregnancy, your egg will be younger but your body will not. Pregnancy basically takes over your body affecting your cardiovascular, digestive and immune systems. The home the fetus will live in for his or her nine formative months is, well...older.

4.  Unless you are currently coupled, you are making this decision on behalf of your partner-to-be, too. By freezing your eggs you are locking in your partner to proceed with assisted reproduction and its financial commitments. As it may be the only real choice for you, hopefully your partner will handle this choice with grace, support and a good sign on bonus.

As women, we pressurize our lives to deliver it all, NOW. We want a partner, and we want kids and we want a career and we want a hobby and we want it all NOW! Or, on the other hand, we give up on a career to have kids, or we give up on having kids to have a career, therefore putting a piece of ourselves in hibernation or in the grave.

May I offer another view? Careers are only as all-consuming as we pressure ourselves to make them, and most of us can count with at least four decades in which to advance our careers. Creating life, nurturing a child and helping your son or daughter learn to navigate through humanity is more transcendental, awe-inspiring and fulfilling than any mommy blogger can articulate; but our fertility is limited in time.

Being a working mother is possible. It is even good. Yes, there is a lot more that our nation and companies can do to support working mothers (equal pay, childcare and flexibility), but do you think that progress will happen without working mothers actually working? It won't. Because someone has to be there to tip the domino that makes working motherhood even better.