As I was tuning in to actress Gabrielle Union’s interview promoting her new best-selling book We’re Going to Need More Wine, I was surprised, yet excited to hear her talk openly about her struggles with infertility. Her candid discussions of the emotional turmoil she experienced in her pursuit of bearing children were nothing short of inspiring, resonating with millions of women.
While her public campaign has opened the floodgates of discussion surrounding this topic, most women in their 30s have not really thought about the hard truths of infertility rates and “advanced age” (age 35 and up is considered advanced maternal age).
As a 31-year-old physician, still completing residency with no plans for children in the near future, the idea of potentially struggling to have children can be unsettling. There are millions of young, single women who share these sentiments. The consequence of having a population with more educated women has been childbirth at a later age, compared to childbearing ages in our parents’ generation.
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Advancements in maternal age have come with advancements in technology to help more women realize their dreams of motherhood.
Cryopreservation of eggs has typically been reserved for women undergoing treatments that threaten their fertility, like chemotherapy or radiation. However, there has been a growing trend of women using this technology electively, in anticipation of difficulties conceiving at a later age. For women who are not quite ready to have a baby, cryopreservation is a consideration to counteract the effects of decreased fertility with older eggs.
Cryopreservation can be done for eggs and embryos (egg fertilized with sperm). While pregnancies have been reliably proven with embryo preservation, the jury is still out on the longterm fertility success of egg preservation. Pregnancy rates for egg preservation alone remain low compared to embryo preservation, mainly due to the differences in biology and preservation of eggs compared to embryos as well as fewer numbers of live births recorded from egg preservation.
Both methods involve using hormones to stimulate the ovaries. This is followed by intense monitoring and frequent doctor visits for approximately 2 weeks. Finally, eggs are retrieved transvaginally, typically requiring some anesthesia. This is followed by direct cryopreservation of the egg or insemination with sperm for those doing embryo preservation.
So what do YOU need to know before moving forward?
- The younger you are, the higher the probability of your preserved eggs resulting in a pregnancy. Female fertility actually starts to decline at age 32. Therefore, it is not unreasonable to determine your ovarian reserve and begin your preservation journey at this time. At age 35, you are considered advanced maternal age. Pregnancies from preserved eggs and embryos are possible after this age, they are just significantly more difficult.
- Get a baseline assessment of your fertility from your doctor gynecologist. This is usually a series of blood tests to determine your ovarian reserve. This can give you a more accurate picture of your individual probability of conception and assist with decision making.
- Think hard about when you want to have children. If you don’t anticipate having children for a long time, egg preservation is a reasonable option. However, if you have a partner or anticipate children in the near future, you may want to consider natural conception.
- Budget accordingly because it costs! Egg and embryo preservations are typically not covered by insurance companies. There are a few progressive employers who offer this benefit to their female employees. In the United States, a single cycle to obtain eggs ranges from $6000-$17000, plus an additional $1000-$3000 for medications. However, you should obtain an estimate from your particular insurance company and provider. Keep in mind that some women may require more than one cycle to obtain enough eggs. Storage fees for eggs can be about $400-$600 per pair. Finally, thawing costs can range from $3000-$7000. Unfortunately, these staggering costs do make this an unattainable option for most people.
We are in a different time now where having children at a “younger” age may not be a priority for some women. That is ok! Luckily, as women, we do have good technologies to keep the door of motherhood open for us when we so choose. However, these expensive technologies, although exciting, are not guarantees.
Egg and embryo cryopreservation may slow the biological clock, but it certainly doesn’t stop it. Whatever your goals are for a future family, keep in mind that things just get harder the older you get, no matter how many eggs you may have in storage. It is important to have these conversations early with yourself and determine what option makes the most sense.
As always, maintain an open dialogue with your doctor to give yourself the best chance of successfully conceiving in the future.