Egg freezing: what is it and will your insurance cover it?

Egg freezing: what is it and will your insurance cover it?

I am 28 and childless. While most of my childhood friends have children (and are fantastic mothers), most of my college and city friends do not – choosing careers, travel, and partying over toddlers, playdates, and finger paint. And although it’s not to say we never want children – in fact, more than ever I see myself eventually having a family – it’s that we don’t want children right now. We want to enjoy our partners, rockin’ bods, careers, sex lives, and open schedules before we have children.

And yes, while I know all those things are possible with children, I choose to enjoy them child-free. For as long as I can, I want to lean in at work and climb the corporate ladder, even though I’m underpaid. For as long as I can, I want to jet off to an island for the week and not worry about calling a babysitter. And for as long as I can, I want to have it all, whatever having it all even means anymore.

But am I running out of time? Are my career, travel, and partying plans lessening my chances of having a family? If I want to have children one day, should I freeze my eggs? I’ve thought about this more recently as my 30th birthday looms closer. Although I don’t want a family now, the longer I wait, the harder it will be concieve. Everything in my life seems to point towards motherhood: in the past few months, I’ve moved to the suburbs, I’ve become more obsessed with my dog, I like Crate and Barrel A LOT. But if I continue to wait to start a family, will I lessen my chances of a natural conception?
Did you know that while men produce new, viable sperm throughout their lives (and never seem to age or wrinkle in general), women are born with every single egg they will ever have the rest of their lives? A woman’s eggs age before birth and die at menopause so although it’s important to never be pressured into having a family prematurely, it is vital to know that the longer you wait, the less eggs and chances you have to conceive. Because of that, some women who are not ready to have children now are freezing their eggs to have children later.

What is egg freezing?

Egg freezing – medically termed oöcyte cryopreservation – is when women take hormones to produce multiple eggs, have those eggs then removed from their ovaries, and sent to a lab where they’re frozen and stored until women want to use them to have a baby. Sounds like a sci-film, right? It’s actually a pretty quick, painless procedure that the American Society for Reproductive Therapy has deemed safe and effective. But while they have lifted the experimental label from egg freezing, they still have not endorsed "social freezing" (the industry term for freezing your eggs in order to delay motherhood) because they fear women will overestimate the benefits of it and have unrealistic expectations of what it will do for them.

Why do women freeze their eggs?

Women freeze their eggs for a myriad of reasons.

  • they currently don’t have a partner and worry about carrying a child when they do — as women age, so too do their risks of miscarriage, pregnancy hardships, and birth defects.

  • it takes the pressure off dating; if women want a family eventually, freezing their eggs allows them to be more in control of their dating lives and focus on Mr. Right instead of Mr. Right Now Baby Maker.

  • they’re choosing to further their educations and careers before furthering their families.

  • they have cancer or have history of cancer in their families — not only can cancer make a woman infertile, it can also wreak havoc on her ovaries and cause premature menopause.

When should women freeze their eggs?

Women should freeze their eggs in their 20s and 30s. Since younger eggs freeze better and have a better a chance of surviving the whole process, the earlier women freeze them, the better chance the eggs have of becoming inseminated. Sadly, the longer women wait, the less chance they have of a successful retrieval: women in their early 30s can expect a 50 percent chance that their eggs will be able to make a baby while women 36-38 have a 35 percent chance. If you’re 39 or older, your chances align with in vitro fertilization (IVF) success, teetering around 15-20 percent chance per attempt.

And what about quality? Since I’m already pushing 30, are my eggs cracked and ugly? "An embryologist can observe egg maturity in the lab, but the best assessment of egg quality must await fertilization," says Dr. Philip E. Chenette from the Pacific Fertlity Center of San Francisco. "After the eggs are inseminated, and early embryo development to the d5-7 blastocyst stage begins, quality can be read as the number of chromosomes in the embryo." While the best predictor of egg quality is age, it’s worth stressing that a doctor cannot assess the egg quality until after it has been fertilized.

How does the egg freezing process work?

While egg freezing does sound like the plot of Alien, it’s not too terrible of a process. However, it does require some prep work. When you decide to freeze your eggs, you spend the first month getting blood tests and completing ultrasounds to ensure you’re a good candidate. Once you are cleared to proceed, the actual procedure goes like this: roughly two weeks of hormone injections to produce multiple eggs, frequent trips to the fertility clinic where the ovaries are monitored, and, lastly, egg retrieval under mild sedation. Retrieving the eggs is like drawing blood… out of your vagina: "A needle goes into the ovary and the eggs get gently aspirated out," as PBS describes it.

Intrigued? That was the SparkNotes version of egg freezing, but Dr. Chenette also explained the exact process to me.

The first thing you’ll have to do is generate multiple eggs for retrieval; this phase lasts about ten days. Your doctor will prescribe fertility medications to stimulate follicle growth and produce multiple eggs, and, using a needle (a very fine needle, but a needle nonetheless), you’ll inject these medications just beneath your skin. To monitor the follicle growth and egg production, you’ll then be observed with ultrasounds and lab tests on a regular basis. Once the follicles are ready for retrieval, you’ll stop taking the fertility medication and switch to an ovulation trigger, a hormone that brings on the final phase of egg maturation. Egg retrieval – which is usually scheduled 36 hours after the ovulation trigger – is when the eggs are removed from your ovaries with a fine needle (there’s that needle again!) four hours before the predicted time of ovulation. The retrieval usually takes about 10-15 minutes while you’re under sedation. The retrieved eggs are then rapidly frozen and preserved until you need them.

After the retrieval, you’re home free. Due to the anesthesia, most clinics require someone to take you home where you’ll rest for the remainder of the day and continue business as usual the next day.

Now that you know how the process is done, how many times should you do it? If you want one child, you should only need to do one retrieval, but if you want a large family, then you should do more than one. The average retrieval yields ten to thirteen eggs and each group of six usually produces one reasonable attempt at pregnancy.

Where should a woman freeze her eggs?

Are specific clinics better than others? Is there a Yelp for fertility clinics? Dr. Chenette says the best place to go is wherever there’s an expert team with strong experience and success in both egg freezing and pregnancies: "A board certified reproductive endocrinologist should be providing your care, and a PhD embryologist with ten or more years of experience in the lab should be managing the eggs. A clinic should have excellent education resources and a well-organized patient intake and care system."

You can also go to a party – say goodbye to Tupperware and Mary Kay and hello to fertility festivities! "Fertility companies and specialists are hosting egg freezing parties and other informational gatherings to encourage women to consider freezing their eggs as an ‘insurance policy,’ and in some cases offer Groupon-style discounts if they commit immediately."

Is egg freezing safe?

Although the surgical procedures are mostly safe and create babies just as healthy as if they were created the old-fashioned way, there are risks. The hormone shots carry a risk of ovarian hyperstimulation syndrome (OHSS) which can make some women ill or even prove fatal in extremely rare cases. Fortunately, OHSS occurs in less than 5 percent of women. Dr. Chenette says OHSS occurs when large numbers of follicles (more than 20) are stimulated, and that it’s more common in younger women who have polycystic ovary syndrome (PCOS) or irregular menstrual cycles. The hormones also cause mood swings and bloating. (For realz, though, what else is new? Mood swings and bloating are just another Tuesday night for typical woman thanks to all the side effects of every drug and birth control on the market and every heinous month of menstruation.)

How much does egg freezing cost?

Since most health insurance companies do not cover egg freezing (it’s considered an elective process like Botox or breast enhancements), expenses must be paid of out of pocket and can cost tens of thousands of dollars. If you live a big city, it will cost you more, but no matter where you live, it’s expensive as hell. Primarily, the Big C is the only way insurance companies pay up. In a CNN article, Dr. Jeffrey Steinberg said, "... if a woman is diagnosed with cancer or has to undergo surgery, radiation, chemotherapy or some sort of medical procedure that will render her infertile, we can usually get the insurance company to cover the process."
If you don’t have cancer (and hopefully you don’t and never will), here’s the cost breakdown:

  • An anti-Mullerian hormone (AMH) test (which is given in order to determine how many eggs you’re likely to make) costs about $250.

  • Egg collection can range anywhere from $7,000 to $15,000 per attempt.

  • Drugs (like the pre-measured injection of follicle-stimulating hormone FSH) will cost $2,500-$7,000 per attempt.

  • Storage costs will set you back $500 upfront and $250 annually.

  • Thawing and insemination costs $7,500.

And although many facilities have financing programs to help women who can’t afford it, the whole process can cost you around $50,000.

Are there cheaper alternatives?

Fortunately, some clinics do offer package deals to lighten the financial load – the more rounds of egg retrieval you do, the less money you’ll pay. If you don’t wish to dip into your savings or retirement accounts to freeze your eggs, you can get creative and get your parents to fund it, buy drugs from another country’s pharmacy, or troll online for leftover drugs.

And although it’s controversial and slow to take off in the United States, there is a cheaper drug regimen that Dr. Sherman Silber told Slate "uses about one-tenth of the amount of drugs than the typical protocol, eliminates the risk of hyperstimulation, and is gentler on women’s bodies (and moods!)." How does it work? Basically, a woman takes less hormone shots (only five or so compared to twenty) than the traditional regimen, and less drugs means less money. The downside? Less drugs and less money means less eggs, and when it comes to egg freezing, the more the merrier. However, in the same Slate article, Dr. John Zhang insists less eggs does not necessarily mean less chances: "The ovaries have limits to producing good quality eggs. No matter how many eggs you produce per cycle, you don’t have more than three to four good eggs that can result in live babies."

Even though it’s been slow to take off in the U.S., more clinics should at least offer the cheaper, minimum stimulation alternative. It’s more cost-effective for doctors, and it’s nice to give women options.
Another option for women delaying having children is embryo freezing. According to The Huffington Post, women who already have partners (specifically ones they like) should consider it since eggs are delicate, and not all of them will survive the thawing process. Mixing your partner’s sperm with your eggs aka making an embryo will increase your odds of success (and cut some costs) if and when you decide to have children.

Do any companies cover egg freezing?

"Costs are covered on a state-by-state basis, and on an insurance by insurance basis," says Dr. Chenette. "Consumers need to check their benefits carefully. Since companies such as Google, Yahoo, Apple, Facebook, CitiGroup, JP Morgan Chase and Microsoft are offering an egg freezing benefit, referencing these companies might help women bring this up to their employers."

According to Mercer’s annual survey of employer health benefits, high-tech companies are more likely to cover fertility services compared to other firms – 45 percent of them cover IVF and 27 percent cover other reproductive procedures like egg freezing. In companies with 500 or more employees, roughly one-third provide no coverage for any fertility services.

But when companies cover egg freezing for employees, is it because women truly run the world and can have it all at work and home? Or is it because companies (and society) are reminding women that yes, they can have babies, but not if they want a successful career? Is paying for egg freezing progressive or regressive?

In a 2013 survey published in the journal Fertility and Sterility, the majority of women were empowered by their choice to freeze their eggs. Men, too, are freezing their sperm and delaying families to focus first on their education, careers, and relationships (the longer men wait, the greater the risk of them passing diseases or mental disorders to their children).

"In our experience, women are relieved that they have the choice and opportunity for fertility preservation," says Dr. Chenette. "They are not expressing career pressure to do this, but rather empowerment and relief to have the opportunity to preserve their future reproductive potential. Any benefit companies offer that may appeal to working women and men can be positive depending on the individual and their circumstance."
Throughout my research, fortunately, all accounts and stories of egg freezing seem to mirror Dr. Chenette and the 2013 survey. Women like and deserve choices, and if employers and insurance companies are willing to back those choices, perhaps it’s without ulterior motive. Perhaps it’s because they’re valued – both as women and as mothers – and their choices are valued at home and work. Hopefully since powerhouse companies like Google, Apple, and Facebook see the benefit of women – mothers, mothers-to-be, and mothers-never-to-be – there is a tide turning in how women are viewed in the workplace, and effectively, the world.

Image: Brenda Gottsabend