Transcription
Fertility rates in the United States are near historic lows. One reason is a sharp decline over the last three decades in the number of American women having babies in their 20s. And yet there's been no change in women's biology or the age at which fertility declines. Unsolvable problem. Enter egg freezing.
Freezing embryos for in vitro fertilization, IVF, has been possible for decades. But freezing unfertilized eggs was a tougher scientific challenge. Used initially for patients with cancer and other conditions that threatened fertility. Egg freezing for non-medical reasons became an accepted practice 12 years ago. And since then, demand has skyrocketed with hundreds of thousands of eggs now frozen, raising big money, big hopes, and big questions. Could egg freezing offer women what previous generations only dreamed of, the chance to put that dreaded ticking of the biological clock on ice. The story will continue in a moment.
Early one rainy Tuesday, Kate Sonderger came to a fertility clinic in Midtown Manhattan to undergo a minor surgical procedure to harvest and then freeze her eggs down here. The next morning, Hi. Hi. At a different fertility center, we scrubbed up and met another egg freezing patient, Katherine Schneider. How are you feeling? Excited. Her doctor, Tor Singer, head of Northwell Health's fertility practice, escorted her into the O. Let's get some eggs. Let's go. Let's get some eggs.
Egg retrieval is the culmination of an arduous process. Nearly 2 weeks of daily self-administered hormone injections, sometimes several a day. The shots induce the ovaries to ripen multiple follicles, the sacks that contain eggs, so that a surgeon can go in with a tiny needle. You can see the white end of the needle, and drain the fluid in those follicles, which is then run into an adjacent embryology lab to search for the eggs. So, the patient is right around the corner, correct? We watched as a pair of embryologists did the delicate work of maneuvering tiny pipets under a microscope to find and isolate Catherine's egg cells in the fluid. And here are all the eggs together. See 1 2 3 4 5 6 seven black balls are Yeah, that those are the eggs. Those are the eggs. Oh my goodness.
After a few hours, the eggs are put onto tiny special straws, then plunged into liquid nitrogen and stored in tanks at 320° where they will stay possibly for years until their owner is ready to thaw them, add sperm. And after we inject the sperm, it fertilizes and turn them into embryos, which is effectively the second half of IVF. According to the data thus far, as with IVF, there are no differences in the health of babies born from frozen eggs. I think that egg freezing is as revolutionary as the pill was in 1960s and '7s. It's as revolutionary as the pill. Yeah. That changed everything as you know. I know. Women had the option of choosing who to be with and not to accidentally get pregnant with the wrong guy. And egg freezing took it an extra level. So you don't have to have a baby at 30 because you're 30 or 35. You can delay fertility into your 40s. You'll have women having kids in their late 40s with their own eggs that were freezing in their 20s and 30s. There's that famous painting of the young woman with tears going down her face. Oops, I forgot to have a baby. That won't be true anymore. Correct. I think that we're pushing the envelope. I'm currently 40. I froze my eggs when I was 35. The first time I did it, I was 34 years old and the second time I was 36. I did two cycles last year when I was 34.
We spoke to a group of women about their decision to freeze their eggs. Why is it a good idea? I 100% know that I really would love to have children. Yasmin Higgby is 29, works in consulting, and has a serious boyfriend. I'll be able to enjoy these times with my partner a bit more instead of rushing to have kids because there definitely is that tick- tock clock that started and I'm not ready quite yet. It's an insurance. I know that, you know, I'm going to be an older mother. Nam Jacob, 38, a healthc care administrator and strategist, isn't ready yet because she hasn't found the right partner. It takes a stress away from dating. You're not pressured to find someone and settle down and get married. You don't hear the ticking. That damn biological clock. It ticks in every woman's head. Amazing. Like it or not, says Dr. for Lucky Secon of Fertility Clinic RMA of New York. That damn clock is very real. We're born with all of the eggs that we're ever going to have and we don't make new eggs and we can't fix or repair them. It's always decreasing over time. So, you're born with a number. Yes. And it starts decreasing right away. It pretty much starts decreasing even before you're born. You're a fetus in your mother's womb at 20 weeks and that's when you have the peak number of eggs, six to seven million eggs at 20 weeks. Yes. And from then on the number keeps going down and the eggs keep aging. So when you freeze an egg, you are stopping it from aging any further. Correct. So if you remove the egg and freeze it when you're 28, right? That egg is 28 years old. Yep. Until you saw it. Yes, it's incredible because it's not just the quantity of women's eggs that decreases with age. It's also their quality, meaning their likelihood of becoming a baby. Even at peak fertility in women's 20s, some 25% of eggs when combined with sperm will create embryos that are chromosomally abnormal and will likely lead to miscarriages. And the percentages rise from there. As you get to 35, that number has steadily increased to about 30 to 35% of embryos being abnormal from your 35-year-old eggs. At 37 38 years of age, 50%. That's a turning point. Things start to move more rapidly. And at 40, you're looking at 60 to 70% of embryos being abnormal. By 45, 90%. 90%. Correct. A lot of times people think that if they've done all the right things, if they've led a healthy lifestyle, they do yoga, they've never smoked a cigarette in their life, they feel younger than their age, and they feel like their eggs will be younger than their age. And I have to explain to them that we have no data to suggest that you can influence your egg quality in that way, unfortunately. Is there an optimal age to freeze your eggs? Yes, your 20s because that's when you're at your lowest possible rate of genetic errors in the embryos that result from those eggs. And you also have a lot more eggs at that age. Okay.
Kate decided to freeze her eggs at the unusually young age of 22 because she's going to medical school and knows she has a long journey ahead of her. You know, education for four years, training for anywhere from four to seven years after that. And so, I'm not even going to think about building a family personally until after I'm done with all of that. Younger and younger women are beginning to freeze their eggs. When I started doing egg freezing in 2012, most of the women were 40, 41, 42. When I see patients today, most of them are late 20s, early 30s. He says there used to be a stigma as though freezing eggs meant something hadn't worked out in a patient's life, but not anymore. It became a common thing. It's almost empowering. You come in, I'm in my 30s. I'm not ready for a baby. I want to freeze my eggs. I'm not going to compromise on the wrong guy.
Freezing eggs is expensive. A single cycle, including medication, costs an average of 12 to $15,000, plus another $500 to a,000 each year for storage to thaw and fertilize the eggs. Later on, costs an additional $10,000. Back in 2014, Apple and Facebook made headlines when they started offering egg freezing as a covered benefit for their employees. Today, more than a third of the largest corporations in the US, those with 20,000 or more employees, cover egg freezing. Our parent company, Paramount, among them. When I was job searching, it was something I was really looking for from a Karissa Simick changed jobs three years ago. More and more companies started to offer it or I was seeing it. So, that was a consideration. Absolutely. As to where you worked. Yes. Absolutely. Her egg freezing cycles were covered as were Neamas's. But there's also been criticism of those companies motives. There are some people who feel that the companies do that to keep you at work so that you won't have a child and leave. Not to make you happy, but to keep you at your desk. I personally don't see it that way. When I learned about the fact that they're offering this really wonderful benefit, it made me more dedicated and committed to my company. Actually, it's a good way to retain top talent.
My insurance did not cover egg freezing at the time. Tina Rampino, now 46, learned about egg freezing in its early days when she went for a routine doctor's visit at age 35 and got a message she wasn't expecting. My gynecologist said to me, "Have kids now. You're running out of time. You can get married whenever you want to get married, but you can't have kids forever." Whoa. And I I went home and I I think I cried and I was like, "What should I do?" The doctor had mentioned egg freezing. And I said, "You know, this is kind of scary, but I decided to do it." Paying out of pocket, she froze 10 eggs, which she considered her backup plan. I did not have a partner. Lindsay Smithson Stanley also paid out of pocket when she froze her eggs at 35. A few years later, she got engaged to Paul. They want children, but not until they're married and Lindsay finishes her PhD. There's a very good chance that we'll get another. So, Dr. Singer recommended thawing her 18 frozen eggs, fertilizing them with Paul's sperm, and then doing genetic testing to assess viability. And that's a day five hatching, which is possible once fertilized eggs grow into 5 to 7 day old embryos. The results, Lindsay and Paul have four chromosomally normal embryos on ice waiting for them. Do they tell you the gender? We have two boys and two girls. You can't stop grinning. It's exciting.
Tina's story took a different turn. After the pandemic, still single, she decided to become a single mother by choice and selected a sperm donor. I had just turned 40 and I knew that motherhood was something that I always wanted. Sorry, I'm like a But the first embryo created from her frozen eggs failed to implant. But then where's Christopher? There's Christopher. A second embryo from her frozen eggs did. She gave birth to a son, Christopher. He's such a happy, healthy boy. He's so playful. He loves people. On the day that I started my egg freezing cycle, I screenshotted a quote that said, "Do something today that your future self will thank you for." And that is something that I think about all the time because that really was the decision that changed my life. But not every egg freezing story has such a happy ending. It was just devastating. It's really the worst thing that's ever happened to me by far. They think they have an insurance policy that they don't have. Does egg freezing promise young women more than it can deliver? When we come back, More and more American women are freezing their eggs to preserve their fertility. The number of procedures has increased more than six times over from 6,000 in 2014 to more than 39,000 in 2023 with numbers continuing to go up from there. Investors have taken notice, seeing a market that could one day include a significant percentage of all young American women. Venture capital and private equity firms have backed egg freezing startups and have bought up and invested in existing private and academic fertility clinics to consolidate them into giant networks. But not everyone is convinced that egg freezing is such a gift to young women. The story will continue in a moment. You're taking the financial cost. You're taking the medical cost for what? For a gamble. Vard Ravitzki is president of the Hastings Center, a bioeththics research institute, and is a senior lecturer at Harvard Medical School. The women we've spoken to, they're almost giddy with this choice. They say that they're freezing the biological clock. That ticking thing is, you know, unbearable and it's gone. I totally understand why young women are excited about it. My fear when I hear young women say, "I froze the biological clock," is that they think this is guaranteed. They think, "I put a baby on ice, not my eggs, and I'm just going to go and thaw it when I'm ready to become a mother." It's not that. That's the problem.
She points to stories like Evelyn Gznos's. Evelyn froze her eggs three times at ages 32, 36, and 38 for a total of 30 eggs. Considered a very safe number. Did you have some level of comfort? Absolutely. Even my doctor was like, "That's insane. Like, you're this is going to be a breeze. Totally no problem." But when Evelyn and her now fiance Edward went to use her 30 frozen eggs, only 19 survived the thaw. An unusually poor result. Even worse, once those 19 eggs were fertilized, only one grew to be an embryo. Anxiously hoping for positive results, they sent a few cells off for genetic testing to see if the embryo was viable. So, I was at work and got this message saying, "Um, we have your test results before we give them to you. Just confirming if you want to know the sex, boy, girl." I just started to think, "Oh, wow. They've asked me this. If I want to know the sex, it means that there's a real embryo there. It means that this is real. It's normal. It's going to be fine. It's all going to be good." And then boom, I get the report and I open it and it's abnormal and it was a girl. There was no chance the embryo could become a baby. Stories like Evelyn's are heartbreaking and though rare, there have also been incidents where a storage tank has malfunctioned and thousands of eggs and embryos have been destroyed. Dr. Lucky Secon says she explains to all her patients that frozen eggs can never be a guarantee because just as in naturally occurring pregnancies, there is drop off at every step along the way. She calls it an inverted pyramid. Like you start out with this many eggs and then this many fertilize. This many turn into embryos. This many embryos are actually genetically healthy and this many embryos actually implant. You're taking a bet. It's a gamble that you'll actually need these eggs. It's a gamble that it would work. And even if you manage to get pregnant, the older you are, the riskier it is to be pregnant. So, you're taking multiple risks. You're gambling on multiple stages. But are you saying don't do it? You know, Leslie, I'm not saying don't do it. I'm saying it's probably a good option for some people, but I would like young women to really have options.
She believes that society pushes high achieving women to get so much accomplished before they have children that they run out of time and it would be better if they could become mothers younger. The optimal time from a biological medical perspective is in your 20s or early 30s, but the socially optimal time is later than that. So I think we're telling women, oh, in your 20s, focus on your education, your career, finding a partner, having financial stability, relationship stability, so that when you do have a baby, you can be a responsible mother. I mean, you're making it sound as if that's wrong. It sounds pretty right to me. What's wrong with that? I think elective egg freezing sends women a message of, "Okay, don't worry. We have a solution for you. Delay motherhood. It will cost you thousands of dollars. It does involve medical risks. Um, there's a good chance it won't work at the end. And if it does work, your pregnancy will be riskier for you and for your baby. But that's okay. We have a solution." A better solution, she argues, would be to have policies like paid parental leave, flexible hours, child care at the workplace to make it easier for women to have babies younger, who's dating. But these women told us they weren't ready to have children younger, still active and trying to find the right person and say they understand there's never certainty. How do they explain that it's not a guarantee? They said exactly those words. It is not a guarantee.
So, what are the chances of success if you freeze your eggs? A 2022 study from one large fertility center found that 70% of women who froze at least 20 eggs before the age of 38 had a baby. But success rates dropped off considerably the older women were and the fewer eggs they froze. Which means that many women like Cararissa and Nema do more than one round of egg freezing to bank more eggs. And that brings us back to the money. Business is booming in the field of fertility. And egg freezing is a big part of it. Companies target women with catchy ads on social media, host fun events like fitness classes, even a manicure to give women information and draw them in. What I've seen is a transition in my own field. Dr. Marcel Cedars, a fertility specialist with the University of California, San Francisco and a past president of the American Society for Reproductive Medicine, says getting women information is great, but she worries that the emphasis on profits she's seeing in private equitybacked fertility companies is creating warped incentives. Have you heard in any companies that are owned by large firms that the doctors are being pressured to encourage more cycles, encourage things that will lead to more revenue? I would hope it's not universal, but that is definitely occurring in some companies. How quickly do you get someone? How many cycles do you get per patient? That's how revenue is based. That's how payment and compensation is based. And so that's what the motivation becomes. It becomes much more a business. It does. I mean I have always bristled when I hear my specialty called an industry and I think in the past it wasn't but I do think it is becoming that and it is painful to me. Pink number 14. She also worries about the unfairness when lower income women and those who don't work for large companies can't afford egg freezing. Vardet Ravitzki agrees. The majority of women who freeze their eggs electively are white and wellresourced and there's a significant gap in your options and your reproductive autonomy if you have resources or you don't. Everyone cannot do this, right? Poor women. I think we have a lot of work to do as a field. We don't yet know how to properly drive down the cost. It's a very expensive endeavor. If this is being done just for someone's peace of mind, right? Should they go through this? I think it depends on their age and attitude towards family building. If someone says to me, I'm 35. I know I want children, then yes, I think they should absolutely do this. Especially if they say, I want to have more than one child because, you know, they might be ready at 37, 38 and have no trouble at all. But when are they going to be ready for baby number two? Stars.
Speaking of baby number two, Tina gave birth to a second little boy, Christopher's baby brother, Theo, in July from the final embryo from her frozen eggs. See the cars? Egg freezing technology, Northwells Dr. Singer thinks will get better and better. Do you think that one day virtually every young woman will do this is it would be routine? I really do think so. Once it's going to be affordable, covered by insurance. I'm a big believer that egg freezing and IVF is going to be the way our next generation will expand. I think that uh having timed intercourse or unprotected intercourse for reproduction is going to be falling out of favor in the next generation or so. Wait, wait, what? Yeah, I think what did you just say? I said that sex is going to be for fun and for pleasure, but most likely in a generation from now when couples want to have kids, most likely they're going to be using artificial reproductive technique. You'll have frozen eggs. Wait, are you saying that we won't have sex to have children? I'm sure my 2-year-old will ask me, "Mom, dad, you had unprotected intercourse. What about chromosomal abnormalities, miscarriages, twins? What were you doing Russian roulette?" Dr. Singer thinks in the future all women will freeze their eggs so that the only reason to have sex is for fun. He would say that. While they didn't seem entirely convinced of that, they are definitely with him on egg freezing. and the need for more education. Should gynecologists talk about this when you go in and you're young? Yes. Absolutely. Yes. I wonder why they don't. I think our health classes were always this is how you don't get pregnant. And I think opening the conversation to this is how your body works. This is, you know, at what age you might want to consider this if you want a family. Knowledge is just power in this circumstance. If a woman goes to her gynecologist, do you think that doctor should introduce the subject? I think it's a good idea. I do. It's a very sensitive topic, so you have to kind of navigate it carefully. You don't want to be judgmental. Not everyone has to freeze their eggs. Not everyone has to have children, but everyone should take the moment to consider their options and really think about what they want. Breaking down the high cost of egg freezing. The majority of women have to pay out of pocket at 60 minutesovertime.com. Sponsored by Nerkche ODT.